[Congressional Record Volume 163, Number 104 (Monday, June 19, 2017)]
[Senate]
[Pages S3580-S3605]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare Legislation
Mr. President, I was elected to the Senate in 2000. I came here in
2001. Two days after I was elected, I called Tom Daschle, the
Democratic leader in the Senate, and I said: I understand I need to
explain my choice and preferences for committees to you.
He said: Yes. You should give me a letter today that tells me which
committees you would like to be on.
I am not sure how they work it on the Republican side, but that is
the way we did it here and, I presume, still do.
I said: My first three choices to be on committees would be--my first
choice would be the Finance Committee, my second choice would be the
Finance Committee, and my third choice would be the Finance Committee.
He said: You want to be on the Finance Committee, don't you?
I said: Yes, I do.
He said: So does everybody else. You have to get in line.
So I did. It took me 8 years. I got on some great committees in the
interim, including the Banking Committee, Commerce, Environment and
Public Works, Homeland Security, Governmental Affairs, and others as
well, even Aging for a while. Eventually I got on the Finance
Committee--in 2009. That was the year we had a new President, Barack
Obama, and a new Vice President, Joe Biden. The hope from our new
leaders was that we would do something Presidents since Harry Truman
have wanted to do, and that was to provide healthcare coverage for just
about everybody in our country. We weren't sure exactly how to go about
it.
We did our homework and found that in 1993, when First Lady Hillary
Clinton came up and worked on something called HillaryCare, the
Republicans felt like they had to come up with an alternative, which
was provided by the people at Heritage, a Republican think tank. What
they came up with had five components to it and was introduced as
stand-alone legislation by John Chafee and cosponsored by Orrin Hatch,
Chuck Grassley, and I think about 20 other Republican Senators.
In the end, HillaryCare didn't go anywhere. The Chafee bill didn't go
anywhere, but it lived on beyond 1993 and that Congress. When Mitt
Romney was Governor of Massachusetts and was going to run for
President, he took that 1993 legislation, which called for creating
exchanges in every State and marketplaces and large purchasing pools
where people who didn't have healthcare coverage could buy healthcare
coverage in their State. The 1993 legislation had sliding-scale tax
credits so people buying coverage on the exchanges could get a tax
credit to help buy down the cost of their coverage. The idea was that
folks whose incomes were low would get a bigger tax credit, and those
whose incomes got larger and larger would eventually not qualify for
anything at all. But there was a sliding-scale tax credit.
Another provision in the 1993 legislation Mitt Romney borrowed was
the idea of having individual mandates so that people had to get
coverage in Massachusetts, and if they didn't, they had to pay a fine.
The idea was that we need for folks to get coverage. We need to make
sure these exchanges--if they were going to have them in the State,
that they wouldn't have people just sign up for coverage in the
exchanges when they get sick and run up the tab a lot for the insurance
companies. The insurance companies said they couldn't make money doing
that. So in Massachusetts, they had the individual mandate.
They also had an employer mandate that employers with a certain
number of employees had to provide coverage for their people. They
didn't have to pay for it all, but they had to offer them coverage.
The last thing Governor Romney took from the 1993 legislation by
Senator Chafee and others was the idea that insurance companies could
not deny coverage to folks with preexisting conditions.
Mitt Romney thought those were pretty good ideas and made them sort
of the centerpiece of what they called RomneyCare in Massachusetts,
which became the law and ultimately extended coverage to a lot of
people who didn't have it.
Initially, they didn't do a very good job on affordability. I am told
by folks in Massachusetts that one of the reasons was that the fine
associated with the individual mandate wasn't very big. Eventually it
was scaled up, but it took a while to get to a point where young people
said: I am paying this fine; I may as well get coverage and stop paying
the fine and get something for my money.
RomneyCare ended up being pretty successful. He ran for President,
and one of the linchpins he used is, look, we have already done what
Barack Obama wants to do. We are already providing healthcare coverage
for people in my state.
In any event, in 2009 I ended up on the Finance Committee. We spent a
huge amount of time in 2009 trying to figure out what this healthcare
plan should look like that our new President and new Vice President
wanted us to do. It looked a lot like what was offered in 1993, and it
looked a lot like what was actually adopted and I think worked with
relative success in Massachusetts.
We held a lot of hearings. I remember being on the Finance Committee.
It seemed like for week after week after week, we had hearings, we had
roundtables, we had discussions, we had meetings off the floor and on
the floor to talk about whether it made sense. We went for an extended
period of time where we had three Democrats and three Republicans on
the committee who met endlessly to try to figure out what the
reasonable compromises were that would enable us to extend coverage to
everybody in an affordable kind of way.
We ended up having an extensive markup, voting, and debating the
legislation in both the Finance Committee and the HELP Committee.
People had the opportunity to offer amendments, a number of which were
offered and adopted by Democrats and Republicans alike. I don't
remember exactly, but I seem to recall that in the Health, Education,
Labor, and Pensions Committee, something like 300 amendments may have
been offered, 160 by Republicans that were adopted.
Long story short, we finally had a chance to finish the debate, and
it became law.
I know our Republican friends don't feel like they had much of a
chance to be involved, but my recollection is that there was a lot of
involvement by both sides. I thought at times that the debate on this
legislation would never end. It finally did, and we finally passed it
on a close margin.
The reason I bring this up is that was my first year on the Finance
Committee. I loved it. I was on there with Senator Stabenow and a
number of others, and we were actually legislating. It was fun. It was
challenging. We were trying to develop consensus. I want us to do that
again.
As good as we think the Affordable Care Act is, I know it is not
perfect. I think everybody in this Chamber knows it is not perfect. But
the idea of preserving what needs to be preserved and fixing what needs
to be fixed is what we ought to be about.
As smart as our Republican friends are, they can't do this by
themselves, and as smart as we like to think we are, neither can we. In
this case, we would be a lot better off doing this together. I know
Senator Schumer has asked the Republican leader for us to meet later
this week--maybe Thursday--in the Old Senate Chamber and just talk it
over.
[[Page S3581]]
John Kennedy used to say that we shouldn't be afraid to negotiate. He
had a great quote about being afraid. He basically said we should never
be afraid to negotiate or talk. I think that probably pertains to us
today.
I thank the Senator from New Jersey for yielding his time to me to
give me a chance to say something again to my Republican colleagues.
I was in Tanzania, Africa, a couple of years ago for an Aspen
Institute seminar with Democrats and Republicans, House and Senate. I
learned a lot about Africa. One of the things I learned was a great
African proverb. A lot of people have heard it; I had never heard it
before. It goes something like this: If you want to go fast, go alone.
If you want to go far, go together. On something this important, we
need to go together, and we will be glad we did.
The PRESIDING OFFICER. The Senator from California.
Ms. HARRIS. Mr. President, Senator Carper talked about Tanzania. It
reminds me of a greeting I have often heard from people who live in
various African countries. When you meet someone for the first time,
instead of what we would normally say--``Pleased to meet you''--the
greeting is ``I see you.'' I see you. I think that really is part of
our concern here: Do we see the people who will be impacted in the way
they are actually living their lives, and do we understand, if we see
them, that this bill will not be in their best interests?
Right now, for example, we know 13 Senators--all Republicans--are
crafting a bill. This bill would restructure our Nation's entire
healthcare system, which, when we add up what Americans spend on
hospitals, doctors, prescription drugs, and all the rest, we understand
it makes up one-sixth of our economy. It would affect the lives of
everyone--our parents, grandparents, those who are in need of
caregiving, our children struggling with asthma or opioid abuse, our
spouses, who may be battling cancer.
What is equally distressing is that this bill is being written in
secret. The chairman of the Finance Committee says he has not seen the
bill. The Secretary of Health and Human Services says he has not seen
the bill. The American people, the people we all represent, have
certainly not seen the bill.
I think the American people deserve better. This bill is being
written entirely along partisan lines without any attempt to bring
Democrats on board, and the American people deserve better. This bill
is being written and rushed through the Senate with hardly any time to
debate the cost or the details of this proposal, and the American
people deserve better.
I remember when our colleagues across the aisle said the Affordable
Care Act was being rammed down the American people's throats in the
middle of the night. The ACA, in fact, went through 106 public
hearings. It incorporated more than 170 Republican amendments. The
whole process took an entire year. But this healthcare plan involves no
hearings, no bill text, and no transparency at all.
As Senators, we were sent here to represent the American people. We
answer to the American people.
Why are my colleagues from across the aisle trying to put one over on
the American people? I have met folks all across California and this
country, and they see what is happening. They know that if this bill
were as wonderful as its proponents would like us to believe, it would
be out in the open.
The American people deserve greater transparency. Even though the
authors of this proposal have tried to conceal the details of their
plan, we know enough to know this bill would be nothing short of a
disaster. We know because we have been told it is about 80 percent the
same as the bill that was passed by the House--a bill so catastrophic
that even the President of the United States who hailed its passage now
calls it ``mean.''
We know it would throw 23 million Americans off their health
insurance within a decade, including putting 4 to 5 million
Californians at risk of losing coverage. We know it would raise costs
for middle-class families and seniors. In every county of California,
average monthly premium costs would go up while financial support to
pay premiums would fall.
We know it would put Americans with preexisting conditions at risk
and leave people who need maternity care or opioid treatment without
coverage or force them to pay huge out-of-pocket costs. We know it
would cut about $834 billion from Medicaid, which means less money for
families to pay for nursing homes, to support children with special
needs, or to treat substance abuse. We need the Affordable Care Act to
be in place, in a way that we fix what is wrong, but we mend what is
broken and not repeal it altogether.
I recently visited a really remarkable treatment clinic in Los
Angeles. It is called the Martin Luther King Jr. Outpatient Center.
Everyone from the doctors to the patients can tell you that when 4,600
Californians are dying every year from substance abuse and opioid
overdoses, it is wrong and irrational to cut Medicaid.
It really makes you wonder why anyone would support this bill. How
does this bill help real people with real challenges?
At a healthcare rally in Los Angeles in January, I met a woman named
Tonia. Before the ACA, she had signed up for insurance just long enough
to see a doctor, have a few tests done, and fill a prescription. Then
she would realize she couldn't pay and couldn't afford to pay for the
insurance beyond that. She said:
It's the worst feeling in the world to have to tell your
doctor--who is trying to make you well--that you cannot
afford the treatment prescribed.
Tonia told me:
Before the Affordable Care Act, living without health
coverage was a nightmare in this country.
She went on to say:
But that has all changed, and thanks to the ACA I can now
see a doctor when I need to, monitor my condition, and stay
healthy so that I can keep working and contribute to our
nation's economy. If the Republicans in Congress repeal the
law, I don't know what I will do.
I ask, How does the Republican healthcare plan help Tonia?
Another woman, Krista, told me:
I am married with four children, one of whom is a 10-year-
old type one diabetic. He requires daily active insulin
management to stay alive--24 hours a day, 7 days a week.
She went on to say:
Healthcare is not optional for us; even with health
insurance, diabetes management is the type of thing that can
bankrupt you. Without health insurance, I can't imagine. ACA
is a huge relief for my family.
I ask, How does this bill help Krista and her family?
Then, there is Rhett, in Marin County. More than 7 years ago, he was
diagnosed with leukemia. Rhett is 9 years old. He says:
Cancer cells are the bad guys.
This is what he wrote me.
For 3\1/2\ years I took chemo to get the bad guys out. I
had more than one thousand doses of chemotherapy. . . . My
parents had to tell my sister that I might die of cancer.
And then he went on to write:
Thanks to my doctors and nurses, my family and friends, my
church and my community, and the Affordable Care Act . . .
now I'm Gone-with-the-Cancer. I have a pre-existing
condition. Thanks to the Affordable Care Act, my parents
don't worry about losing coverage.
A 9-year-old Rhett is showing us the way. How does this bill help
Rhett?
I don't know the party affiliation of any of these folks. I don't
know if they are Democrats. I don't know if they are Republicans. I
don't know if they are Independents. I don't know if they are members
of the Green Party. I am not asking them those questions. I am asking
them: How are you doing? What is helping you? What do you need? How
will this impact you?
I know I am one of two Senators whom they have. When it comes to
their needs and their need to be represented in the U.S. Congress and
their need to be heard and their need to be seen, party affiliation
should not matter. What should matter are the needs of the American
people.
Regardless of whom they vote for in a partisan election, I am certain
of this. This healthcare plan that is being proposed by my colleagues
from across the aisle will not solve their problems. It will only
create more problems and potentially devastate people's lives.
To my colleagues I say, this shouldn't be a matter of supporting this
bill automatically if you are a Republican or objecting just because
you are a Democrat; this is about what is right and what is wrong.
[[Page S3582]]
If you know this bill is bad, stand up and stop it. Speak that truth.
Now is not the time to keep quiet and hope nobody notices. Forget the
politics. Forget partisan pressure and talk radio and primary ads.
Instead, just listen to the voices of the American people, not just in
California but in Nevada, in Arizona, in Ohio, in Alaska, in Maine, in
Pennsylvania, in West Virginia because they have made themselves
overwhelmingly clear. Only 20 percent of Americans support this bill.
A majority opposes it in every State in this country. It is the least
popular piece of legislation in modern history. I am asking you to
think about the American people. I am asking you to think about Tonia.
Think about Krista. Think about Rhett living with leukemia since he was
just 2\1/2\ years old, undergoing 2\1/2\-hour infusions every night
with such incredible bravery.
Let the determination of Americans like Rhett bring us together--a 9-
year-old boy who tells us, in his words: ``Don't repeal the Affordable
Care Act, Improve it!'' We all agree, the ACA can be improved. It must
be improved. It isn't perfect. I am ready to work with anyone who
really wants to make it better.
Instead of playing politics, instead of playing politics with public
health and people's lives, we can actually work together to strengthen
our healthcare system.
In fact, I am proud to have recently cosponsored a bill with Senator
Dianne Feinstein and a number of my Democratic colleagues. Our bill
would make it safer and easier for middle-class Americans to buy
insurance if they currently don't qualify for any help paying their
premiums.
These are the kinds of solutions Democrats can get behind. These are
the kinds of solutions that would help and not hurt the people we
represent. We took an oath to represent all the people. I am asking
every Member of this Chamber to think long and hard about the
consequences of this bill. Think about the responsibility we have been
entrusted with.
We owe it to the American people to tell the truth, not to hide it.
We owe it to the American people to solve real problems, not to
manufacture new ones. We owe it to the American people to do the job we
were sent here to do.
I urge my colleagues to vote down this bill and stand up for the
people we represent and serve.
I yield back.
The PRESIDING OFFICER. The Senator from Nevada.
Ms. CORTEZ MASTO. Mr. President, I rise to join my colleagues to
speak out on the secret healthcare legislation that Republicans are
attempting to jam through the Senate without any public review or
consideration.
This is an insult to the American people. It is a shameful abdication
of the role of a U.S. Senator to represent the concerns and priorities
of the people of a State and country. We were elected to be a voice for
the people of our individual States. What I am hearing loud and clear
from my State is: Keep the Affordable Care Act. Do not repeal it. Keep
it, and work together to improve it.
Like my colleagues, I wish to share the story of one of the many
Nevadans who have contacted me to share their story about the ACA and
why they so desperately want to avoid its repeal.
Jessica and her husband own a brewery in Reno, NV, and I was lucky
enough to get to meet and speak with her in person when I was home last
month touring the Community Health Alliance Center.
After meeting with her, I had the opportunity to sit and talk with so
many incredible people--doctors, nurses, people who care about the very
faces of women, men, and children we are talking about tonight. This is
Jessica's letter to me, and this is what I would like to share with
you, what she wrote to me.
Dear Senator Cortez Masto,
I am a resident of Nevada, a small business owner, and a
mother. I am writing to express my views about the Affordable
Care Act. The Affordable Care Act has had a tremendously
positive effect on my life, and I would like to share my
story with you.
The Affordable Care Act saved my small business.
When the Patient Protection and Affordable Care Act (ACA)
was signed into law in 2010, and when it was upheld by the
Supreme Court in 2012, my husband and I were in the planning
stages of our small business. At the time, my family was
provided health insurance through my corporate job. Knowing
the ACA would take effect gave me the peace of mind to leave
my job and become a full time small business owner. Today,
our business, Under the Rose Brewing Company, is celebrating
our 4th year in existence, and we are in the beginning stages
of a large expansion, which will create many new jobs in
Reno. This business would not have survived without my full-
time dedication. I would not have been able to leave my
corporate job without the ability to procure affordable
healthcare for my family.
The Affordable Care Act allowed me to start my family in a
healthy way.
As my husband and I prepared to sign up for our first year
of health care with the ACA, we found out that I was
pregnant. Prior to the ACA, health insurers were allowed to
consider pregnancy a ``pre-existing condition.'' Instead of
being denied coverage or charged higher premiums, I was able
to receive appropriate and affordable care during my
pregnancy through the ACA.
The Affordable Care Act saved my life and my baby's life.
30 weeks into my pregnancy, at a regular checkup with our
midwife, my husband and I were advised to see a doctor. Since
I didn't look sick or feel sick, we hesitated, but our
midwife was positive it would be for the best. Our insurance
through ACA allowed us to see the recommended OBGYN. Half way
through our appointment he became very concerned and rushed
me into the hospital. My son was born by emergency C-section
a few hours later. Several doctors agreed that neither the
baby nor myself would have survived a further 24 hours of
pregnancy. Having health insurance through the ACA allowed
my husband and I to seek treatment and care without having
to worry about the affordability of following doctor's
orders. This is the first time I could say that the ACA
saved my life and the life of my beautiful baby boy.
The Affordable Care Act saved my baby's health [and
provided us with health insurance].
Thus my son was born 9 weeks early and was admitted into
the NICU. He stayed in the NICU for 32 days and was under
constant doctor care. By the time he left the hospital, we
had incurred well over 1 million dollars in total costs. The
ACA allowed him to start his life without a cap on his total
lifetime healthcare coverage. Prior to the ACA, many NICU
babies reach their lifetime limits before even feeling the
sunshine on their faces. I am eternally grateful for this
provision of the ACA.
One week after bringing our beautiful baby boy home from
our hospital's NICU, I found myself in need of emergency care
for a second time. I suffered a postpartum stroke. I was
taken to the emergency room and admitted to the hospital for
the second time in 2 months. Again, the ACA allowed me to
seek treatment and care without worrying about coverage.
The Affordable Care Act will save my son's healthcare. My
son now has a medical issue with his growth. Should the ACA
be repealed, amended, or replaced with something less
inclusive, this issue will be considered a preexisting
condition. The thought of my 18-month-old son being denied
coverage, or potentially not being able to afford the
healthcare offered to him, makes me sick to my stomach. Why
would our lawmakers vote to take this away from him? I
implore you to consider the great lengths the Affordable Care
Act has gone to not only improve and save lives in my family,
but families across the Great State of Nevada. I further
implore you to consider the children currently covered and
benefitting from the ACA as you contemplate your vote on this
significant matter. I strongly urge you to defend this
crucial legislation. Too many of your Nevadan constituents
rely on this lifesaving, health-saving and financial-saving
legislation.
Thank you for reading my story and considering my views. I
am happy to speak directly with you.
Sincerely, [Jessica] and family.
Mr. President, I know Jessica's story is one of thousands. I hope my
colleagues across the aisle think of Jesse and her family and the
millions of Americans like her who have so much at stake while
continuing to secretly rewrite our country's healthcare laws.
Thank you for listening.
I yield the floor.
The PRESIDING OFFICER (Mr. Daines). The Senator from Michigan.
Ms. STABENOW. Mr. President, first, I want to thank the Senator from
Nevada. We are so pleased that she is here and her voice is so strong
for the citizens of Nevada and appreciate very much her comments this
evening.
I am rising this evening to talk about an issue that affects every
single person, every single family in Michigan and all across the
Nation, and that is healthcare. I feel very confident that I can say
that each one of the 48 members of the Democratic caucus--each and
every one of us would love to be on this floor working with Republican
colleagues across the aisle to lower the costs of prescription drugs,
to lower the out-of-pocket costs of healthcare, to create more
competition and more
[[Page S3583]]
insurance choices for people in the insurance pools than are there
now--to basically fix the problems.
I am proud to be with colleagues tonight because we are not willing
to support anything that unravels the healthcare system, raises costs,
takes away healthcare for people, and, on top of that, gives a tax cut
to the wealthiest Americans, insurance executives, and pharmaceutical
companies with the dollars that are cut.
So here we are. The House has passed a bill that, in fact, raises
costs, takes away healthcare, gives the tax cuts I talked about. Now we
are in the Senate. The Republicans have a healthcare bill, but they
will not let us see it.
I am the ranking Democrat on the Health Subcommittee of the Finance
Committee. You would think someone would have reached out to have
conversations with me and members of our subcommittee--members of our
whole committee--but that has not happened. They are letting the Trump
administration see it, but not the American public. They are letting K
Street lobbyists see it. That is probably where I will get a copy
first--through lobbyists--but not the American public, who will lose
their healthcare and pay more.
If you have cancer and you are not going to be able to get coverage,
if you are going to potentially be dropped or have preexisting
conditions or get caps put on the number of cancer treatments you can
receive, I believe you have a right to see this bill. If you have
epilepsy and will lose your insurance, you have a right to see this
bill. If you are a woman who will be charged more for insurance and be
considered to have a preexisting condition just because you are a
woman, you have a right to see this bill. If you are senior whose rates
are going to go skyrocketing upward, you have a right to see this bill.
But the sad fact is, Republicans don't think the American people have a
right to know or to see this bill or to review it or to comment on it--
to have a chance to give their opinion on it.
The difference in process couldn't be more clear between the way the
Affordable Care Act was originally worked on for about 18 months and
then passed and what is happening right now. In 2009, Republicans
called for a fair, collaborative, and deliberative legislative process.
I agree. In fact, we all agree.
From 2009 to 2010, the Senate Finance Committee held more than 53
hearings on health reform--hearings, open committee meetings, work
sessions. As a new member of Finance at that time, I was involved in
every single one of those, with hours and hours of listening,
deliberating, people sharing their opinions, and debating. Counting the
HELP Committee deliberations, there were 100 hearings and committee
meetings before the bill was finalized and debated to be reported out
of committee.
The Republicans have had no hearings--zero hearings. They have had no
public meetings--zero public meetings.
During the Finance Committee markup, when we were working through and
voting out the bill, we considered 135 amendments, often late into the
night. The final Senate bill included 147 Republican amendments. In the
end, we were trying to do everything we could to get bipartisan
support, when it was clear that politically there was not a desire--
even with 147 Republican amendments in the bill--to have a bipartisan
healthcare bill.
Republicans will not even allow us to see the bill, let alone amend
it. Our position is very clear. If there is no hearing, there is no
vote. We need them to show us the bill.
There is, I think, a really good reason they will not show us the
bill. They will not let us see it because it is a disaster for the
American people. It is a disaster for the people in Michigan whom I
represent.
From the House bill, we know that 14 million fewer people will be
insured after the first year; 23 million fewer people will be insured
after 10 years. This may change somewhat back and forth. We have no
idea. But we know the general framework the Senate is working in is the
same general framework as the House. We know that in 2026, according to
the Congressional Budget Office, 51 million people under the age of 65
will be uninsured--no insurance.
We are told that premiums would go up 20 percent next year, and
States would be allowed to opt out of key insurance laws that protect
consumers. To really understand what that means--that means all of the
decisions about your care go back to the insurance companies, not your
doctor. Laws that protect people with preexisting conditions are gone.
Rules that prevent women from being charged more are gone. Laws that
prevent seniors from being charged more are gone. And the way it used
to be is that if you got sick, the insurance company could decide to
drop you. It was the insurance company that said how many cancer
treatments you were able to receive or mental health visits, if any,
you would receive. You always paid more than for physical health--the
same with addiction.
This all goes away with what is being talked about here. In other
words, costs are going to go up, and care is going to go down. To add
insult to injury, all of this is going to go to tax cuts for
multimillionaires and billionaires, to drug companies and insurance
companies--while someone is losing nursing home care, cancer
treatments, maternity care, and children will be unable to go to the
doctor and parents forced to go back to using the emergency room.
I want to share with my colleagues what these changes would mean for
people in Michigan. There are so many people I have talked to, so many
stories I have heard. I received a letter from a woman named Amy who
owns a small retail business in Michigan. She has health insurance
through her husband's job--a small business owner. Amy has chronic
myeloid leukemia. It is managed with a medication that costs $20,000 a
month--not a year, a month. After her deductible and 10-percent copay,
she said she quickly reaches the maximum out-of-pocket expense on her
insurance each year. Amy wrote:
Preexisting conditions, maximum out-of-pocket costs and
lifetime cap costs are important to me. . . . [Without them]
I could never afford my health care. Without the ACA, I could
quickly bankrupt my family and still die. . . . Please
consider my situation when deciding your vote on any changes
to the ACA. I need your help. I want and need to stay alive
and raise my children.
Healthcare reform allows Amy to stay on her husband's insurance plan
and pay for the cancer treatments that are keeping her alive. The
Republican plan would put people with preexisting conditions like
cancer at the mercy of health insurance companies.
Here is another way the Republican plan would hurt American families.
Thanks to the Medicaid expansion, 650,000 people are newly covered
under what we call the Healthy Michigan Plan. The good news is, 97
percent of Michigan children can now go to the doctor. They don't have
to wait and go to the emergency room. If they have a cold, their mom or
dad can take them to a doctor. They can get preventive care, rather
than waiting until something awful happens and going to the emergency
room. What is the good news for the State of Michigan out of that?
Michigan will end up, this year going into next year, with $432 million
more in the treasury. Taxpayer dollars aren't going to have to be used
on healthcare because the right thing was done--creating a way for
children to see a doctor. What has happened? We have a 50-percent
reduction on folks who don't have insurance going into the emergency
room, and it saves money when you do that. The number of people treated
has gone down 50 percent--the number of people treated without
insurance.
The great thing about healthcare to understand is that if we ignore
it, it doesn't mean people don't get sick, that they don't get cancer,
that they don't need a nursing home or that their child doesn't get
sick. If you just ignore it, the costs go up because people ultimately
use the most expensive ways to get treated.
If you actually plan it out and do the right thing on the front end
and people can see a doctor and they can get the checkups and the care
they need and the treatments they need, you actually save money. That
is the example of the State of Michigan.
The Republican plan would end the Medicaid expansion. Healthy
Michigan would go away. One young man in Michigan only 19 years old
shared his story of living with his single mom when he was diagnosed
with testicular cancer. He was working, but his employer didn't offer
health insurance. He
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didn't have transportation to get to his appointments or treatments.
Thanks to Healthy Michigan, he got insurance and treatment at Munson
Healthcare in Traverse City. He is now free from cancer, has a job with
benefits, and is engaged to be married, and we wish him well. Healthy
Michigan and the Medicaid expansion saved this young man's life.
The Republican plan would end the Healthy Michigan plan, ripping
coverage from 650,000 people in Michigan, including cancer patients.
And for what? And for what? To pay for tax breaks for drug companies
and the ultrawealthy one more time. This means Michigan families will
be unable to care for their loved ones when they need it most.
In January, I led a forum on Secretary Price's healthcare policies,
and a woman came from Michigan to tell her story. Ann was diagnosed
with multiple sclerosis when she was 40 years old, and she has very
limited use of her arms and legs. We are so grateful that she made the
trip to DC to share her story. Medicare and secondary insurance cover
most of the cost of her medication, which costs an astonishing $75,000
a year. That is nearly her entire household income, including Social
Security benefits.
Ann had been caring for her aging mom when her mom's dementia
worsened. Ann didn't know where she would find the $6,000 a month for
nursing home care. How many families are in that situation?
Fortunately, Ann's mom qualified for Medicaid. By the way, three out
of five seniors in Michigan are able to get their nursing home care
through Medicaid. Three out of five are getting nursing home care
because of Medicaid, including Ann's mom.
This nursing home care paid for the final 3 years of her life. Here
is what Ann said:
It was only because of Medicaid that she was able to get
the help that she needed at the end of her life. I don't know
how I could have cared for my mother on top of managing my
own care. My family would have lost our home and all our
savings in trying to keep up with their bills.
Medicaid helped Ann care for her mom at the end of her life. This is
a good thing.
Again, the Republican plan would cut Medicaid by $834 billion. That
is the House plan coming over. We don't know how much would be cut
here, but we know whatever will be cut will be used to pay for tax
breaks for drug companies, insurance CEOs, millionaires, and
billionaires. How does that reflect American values?
In conclusion, Republicans are hiding their bill because they know it
is a bad deal for American families. It is a bad deal. The President of
the United States called it ``mean.'' I agree with him. It is mean, and
it is definitely a bad deal for the people I represent in Michigan.
Costs go up and care goes down, all to cut taxes for millionaires and
billionaires. We are better than this as a country. Our Nation is
better than this.
It is time for Republicans to show us the bill so we can work on it
together. Give us a chance. Give the American people a chance to have
input, to say what they think before it is forced on them in a secret
process that is rammed through this floor. It is time to move beyond
partisanship to get something done for the American people.
Again, I know that the 48 Democratic Senators in this Chamber want to
work on lowering the cost of prescription drugs, reducing out-of-pocket
costs, helping small businesses that want to provide coverage for their
employees, and making the healthcare system better.
Let's stop this bad bill and work together on behalf of the American
people.
I yield the floor.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. MARKEY. Mr. President, when a Pope dies, the cardinals meet in
secret to select the next Pope. A white cloud goes up in smoke. When
the Senate Republicans meet in secret to craft a healthcare bill,
coverage for the sick, the disabled, and the elderly is what goes up in
smoke--all of that coverage. The only thing more secret than the
Republican healthcare bill is Donald Trump's tax returns.
We might need ultimately to have a special counsel to go and to find
out what is inside of that healthcare bill because right now the
Democrats don't know, the American public doesn't know, and no one
knows what is in that bill. While we may not have details on the
Republicans' secretive proposal to repeal and replace the Affordable
Care Act, we know that they are not completely rewriting the House-
passed legislation that eviscerates the Medicaid Program and reduces
coverage and increases costs for most Americans and for the
individuals, the families, and the communities caught in an opioid
crisis. This bill will be a complete calamity, and it is being done
totally in secret.
Right now, the press is being stifled. The White House didn't even
let reporters audiotape the press briefing today. Last week, the Senate
Republicans tried to keep the press from asking questions of Senators
in the hall. They don't want the press to know about this bill or to
cover it.
But for families who need treatment for opioids, the Republicans want
to take the money from substance use disorder coverage and care and use
it to offset a $5.5 trillion tax cut for the healthy wealthy and for
massive corporations. That would be cruel. It would be immoral. It
would be inhumane. Like President Trump himself has said, it would be
``mean.''
We know the opioid epidemic knows no demographic, economic, or
political boundaries. It has ruined the lives of men and women from
Lexington, MA, to Lexington, KY. It is an equal opportunity destroyer.
That is one of the reasons why, over the last year, combating the
opioid epidemic has been a bipartisan issue.
Eleven months ago, this body passed and sent to the President's desk
the Comprehensive Addiction and Recovery Act. Known as CARA, this
bipartisan law strengthens the States' responses to the opioid crisis,
and it passed the Senate 92 to 2.
Six months ago, the Senate passed the 21st Century Cures Act 94 to 5.
This bill quickly became law and allocated $1 billion to States to
provide much needed resources to help them address the opioid epidemic
on the ground and in their communities.
Yet today Senate Republicans are singlehandedly attempting to betray
that progress and to erase it from the history books. They are doing so
by crafting in secret a bill to gut Medicaid and repeal the Affordable
Care Act and replace it with a shell that hides a massive tax break for
the wealthiest people in our country--people who do not need or deserve
a tax break, especially if it is coming from the healthcare coverage of
those people who are sickest, those people who are oldest, those people
who are most disabled, those people who are most vulnerable to having
an addiction to opioids and need treatment. It would be wrong to take
their money for that healthcare coverage and give it as a tax break to
the wealthiest billionaires in America, who already have enough money
for their healthcare coverage.
This would be a death sentence to the 2.8 million Americans with
substance use disorders, including 220,000 with an opioid use disorder
at risk of losing their insurance coverage altogether in order to
ensure that their family member can get treatment.
For those who do manage to get insurance coverage, TrumpCare will
make it more expensive to get the treatment and the care they need. The
Congressional Budget Office explicitly said that out-of-pocket spending
on mental health and substance abuse services could increase by
thousands of dollars per individual in any one given year. For a
disease as critical as an opioid use disorder, any delay in treatment
can be the difference between life and death, not to mention that,
because TrumpCare reduces protections for people with preexisting
conditions, even those with insurance may find out that the coverage
they have won't work for them when they need it the most. Under the
Republican proposal, a substance use disorder could be classified as a
preexisting condition and, therefore, you couldn't get coverage for it.
The Congressional Budget Office also said that TrumpCare would slash
Medicaid by $834 billion, permanently decapitating Medicaid. They say
they are moving to a per capita system. Another way of saying that, if
you are an
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ordinary person, is decapitation of Medicaid for the families across
our country who need it.
If this becomes law, there is no Narcan for Medicaid. Once it is cut
by TrumpCare, it is dead.
Those devastating cuts would grind the progress we have made in
expanding access to opioid treatment to a screeching halt and kick
people currently in treatment to the curb. Medicaid spent $7 billion on
substance use disorder treatment alone in 2014. That money facilitated
access to care, access to recovery, and access to hope for millions of
Americans. Medicaid can cover in-patient detox treatment, care
coordination, access to naloxone.
Additionally, Medicaid pays for one-third of the medication-assisted
treatments in the country, more than any other payer. In Massachusetts,
Medicaid pays for nearly one-half of the medication-assisted treatment
provided in the Commonwealth. So think about that. One half of the
people who get medication-assisted treatment for opioid addiction will
lose their coverage, and, then, the Republicans are going to take the
money they save and give it to the wealthiest people in our country,
who also need the same coverage, leaving them with the money needed for
those who are the one-half who won't have it. What happens to those
other individuals? It could be a death sentence without treatment.
Those of us from States hardest hit by the opioid epidemic hear time
and again how Medicaid coverage of those services saves lives.
Dawn from Swansea, MA, shared the story of her son, who became
addicted to opioids after experimenting with prescription pain pills
from a family member. Through Medicaid, he was able to access
medication-assisted treatment to help treat his substance use disorder.
Dawn said:
He has done very well with his recovery so far but I fear
that without insurance coverage that will allow him to
continue obtaining his medication and counseling . . . he may
lose all that he has gained and fall back into the cycle of
addiction. His medical insurance is literally his lifeline.
Please don't abandon my son and others like him who need
Medicaid assistance to continue their fight against
addiction.
Instead of recognizing the importance of Medicaid for families like
Dawn's across the country, Republicans are proposing to starve this
lifesaving program from Federal funding through TrumpCare by cutting
more than a quarter of its budget. Because that is not enough to fund
the massive tax breaks that Republicans want for their donor friends,
President Trump has proposed in his budget to cut the program by an
additional $600 billion, leaving Medicaid a shell of its former self.
Although Republicans refer to the changes as capping the Medicaid
Program, for Dawn's son, what that really means is they will decapitate
his access to medication-assisted treatment, decapitate his ability to
seek counseling, and decapitate the peace of mind Dawn receives in
knowing her son is accessing the help he needs.
We also have to consider the Affordable Care Act's Prevention and
Public Health Fund and its role in the opioid epidemic. It is the
Federal Government's single largest investment in prevention.
Since 2010, Massachusetts has received more than $95 million through
the prevention fund. Importantly for Massachusetts, nearly $4.5 million
has been given to the preventive health services block grant that has
helped the State respond to the heroin, prescription drug, and fentanyl
drug crisis. Eliminating this fund will only hurt our ability to
respond to the opioid and other drug epidemics popping up in every one
of our communities.
We should not be building bridges to recovery with money that is
stolen from those programs in order to be spent on a wall that is going
to pretend to block the drugs from coming in from overseas. We should
be building bridges to recovery, not walls to isolation.
Instead of more commissions, we need more commitments from the
administration and congressional Republicans to not undo the progress
we have made in preventing and treating substance abuse disorder. It is
unfortunate that Republicans who touted our progress on opioid issues
aren't standing up to the policies in TrumpCare that would negate their
hard work. By supporting this, they are betraying the families and
communities who have suffered from the relentless grip of substance use
disorders. When discussing the opioid crisis, the only thing the GOP
stands for right now is Gutting Overdose Prevention. That is the new
GOP--Gutting Overdose Prevention.
While devastating, this isn't surprising for those of us who have
been watching many congressional Republicans salivate over ways to
annihilate Medicaid for decades. Republicans harbor an ancient
animosity toward Medicaid. Raiding the Medicaid coffers achieves two of
their goals: First, it kills a lifeline for more than 70 million low-
income and working-class Americans. Second, it provides the GOP a
piggybank to aid their donors and pay for these tax breaks for their
friends. In fact, TrumpCare alone would provide the wealthiest
individuals and national corporations with over $660 billion in tax
breaks over 10 years. Included in this figure is the repeal of the
health insurance tax, which gives a $145 billion tax break to insurance
conglomerations and their CEOs. Millionaires will get a tax break of
$50,000 a year--more than three times the income of most Medicaid
beneficiaries--and the top 400 highest income earners would save $7
million in taxes annually. All of this comes at the expense of the 23
million Americans who will lose health insurance coverage under
TrumpCare.
Don't let the GOP fool you--TrumpCare is not about creating health,
it is about concentrating wealth in the hands of a small number of
Americans. It is about making middle-class and working Americans pay
for a tax break for people who need it least.
We can do better than this. We owe it to the families of the 33,000
Americans who died from an opioid overdose last year. The proposals
under consideration with Republicans is going to only add to the tally
of overdose deaths. We are hearing that Senate Republicans could create
an opioid fund as a paltry attempt to appease those who have called out
the cruelties in this bill. That extra funding would be crumbs. It
would be like trading a full-body cast for a bandaid, like trading land
for a couple of beads, like trading a Cadillac for a tricycle.
We will not be fooled. We know it took Republicans more than 1 year
to agree to providing the funding for emergency opioid response in the
CURES bill. One can only imagine how long it will take to get any money
the Republicans are promoting as a consolation prize out to the
communities who need it. We know that a vote for TrumpCare is a vote to
perpetuate overdose deaths. Passing this bill will be just aiding and
abetting one of public health's most wanted and most notorious serial
killers.
Americans from both political parties are not fooled by President
Trump's tax cut shell game on the backs of families and communities who
have been ravaged by opioids. That is why Democrats will continue to be
a public megaphone and shout from the rooftops that eviscerating
Medicaid to give a tax cut to the healthy and wealthy is mean,
inhumane, and immoral, and we are not going to stand for it, and the
American people are not going to stand for it.
The best vote I ever cast in my political career of 41 years in
Congress was for the Affordable Care Act. The second best vote I will
ever cast is to block the repeal of the Affordable Care Act because of
the good it has done for tens of millions of families in our country
who otherwise would not have the coverage they need.
Mr. President, I yield back the remainder of my time.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. SANDERS. Mr. President, let me thank the Senator from
Massachusetts for his very cogent and important remarks.
Let me just start off by asking the Chair, asking the leader of the
Republican party, what are you afraid of? What are you afraid of?
Health care constitutes one-sixth of the American economy. It impacts
every man, woman, and child in our Nation. Yet we have 13 Republicans,
all men, working behind closed doors to produce legislation that will
be brought to the Senate at the last moment so the American people
don't know the disaster that it is.
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You know, what politics is about or should be about is, if you are
proud of what you do, you tell the world about it. You explain to the
American people and to your constituents why this is what you are
proposing, this is how you voted, and this is why it is good for the
people in your State and your country.
It should tell every American--whether you are a Democrat, a
Republican, or an Independent, whether you are conservative or
progressive, it should tell you something that major legislation is
being written at this moment and that most Republicans don't have a
clue as to what is in that legislation, let alone the Democrats, let
alone average Americans.
So I say to the Republican leadership, what are you afraid of? Bring
out that bill.
I am a member of the Health, Education, Labor, and Pensions
Committee, the HELP Committee. The HELP Committee is supposed to be the
committee that deals with health issues.
I see Senator Murray is here, the ranking member of that committee.
She will concur with me that the HELP Committee has held zero hearings.
It is the HELP Committee. We have had not one hearing to ask members
of the administration, people throughout this country, what the impact
of this legislation will be on the children, on the elderly, on working
families, on those who have chronic diseases, on ordinary Americans.
What impact will this legislation have on the lives of 300-plus million
people? We have not had one hearing, not one open discussion. I would
think that every Republican would be embarrassed by this. I know many
of them are embarrassed by it.
So before there is any vote on any health care legislation, we need
to have a series of hearings to discuss the implications of what the
legislation is about.
Mr. President, as I think you heard during the debate on the
Affordable Care Act--and I am a member of that committee, and we had 47
bipartisan hearings, not only in the Health, Education, Labor, and
Pensions Committee but also in the Finance Committee and other
committees. There were roundtables and there were walkthroughs of the
Affordable Care Act. There was consideration of more than 300
amendments. Some 150 amendments offered by Republicans were accepted.
In 2009 and 2010, the Finance Committee held 53 hearings, meetings,
negotiations, and walkthroughs on the Affordable Care Act. That
committee marked up the Affordable Care Act for 8 days. A markup means
you accept amendments and you have debates on amendments. That was the
longest markup in 22 years, and adopted during that process were over
10 Republican amendments.
When the bill was considered on the Senate floor, the Senate spent 25
consecutive days in session on health reform--the second longest
session in history. Oddly enough and interestingly enough, many of my
Republican colleagues, during that process--after 25 consecutive days
on the Senate floor and after numerous hearings in the HELP Committee
and in the Finance Committee, there were Senators who said that wasn't
enough time. They said: This is such an important piece of legislation,
and it is going to impact so many people. We need even more time.
Senator Enzi said that ``cutting off Senate debate and deliberation
with a budget reconciliation process would shortchange legislation with
enormous impact.''
Senator Lamar Alexander said:
I don't think people are going to feel as good about a bill
that restructures one-sixth of our economy, that affects
every single American's health, and the healthcare bill is
being written behind closed doors in the Democratic leader's
office.
In other words, you had Republican leaders thinking that the hundreds
and hundreds of hours of discussion and debate on the Affordable Care
Act was not enough. I find it amazing that those same Republicans seem
to think it is OK for legislation to be written behind closed doors and
not have one single committee hearing.
Now the truth is, I can understand why Republicans do not want open
discussion and open debate on this issue--because the bill they are
working on, which is based on the disastrous bill passed in the House
last month, is a bill that would do incalculable harm to people all
over our country and really should not be considered as a healthcare
bill.
How do you talk about a so-called healthcare bill when you are
throwing 23 million people off of health insurance? When we talk about
a healthcare bill, the assumption is that we are improving healthcare
in America, not doing what the Republican House bill does--wants to
throw 23 million Americans off of health insurance. Surely that is not
improving healthcare for the American people.
Cutting Medicaid by over $800 billion--and God only knows what the
implication of that will be for the children, for the elderly, for
people who are in nursing homes.
You are not improving healthcare when you defund Planned Parenthood.
After all the rhetoric about choice, choice, choice--we want the
American people to be able to go to their provider of choice--oh, 2.5
million women who today get their healthcare through Planned
Parenthood, I guess their choice doesn't matter.
We hear about the needs of working-class people. We had the candidate
Donald Trump who talked about the needs of working-class people. The
House Republican bill--and we think the Senate bill will be very close
to it--substantially raises premiums for older workers. That is why,
among other groups opposing the House bill, the AARP made the point
that this would be a disaster for older workers.
The truth is, this is not a healthcare bill; this is a tax break for
the rich and multinational corporations bill. This is a bill that would
provide over $200 billion in tax breaks to the top 2 percent. This is a
bill that would provide hundreds of billions of dollars in tax breaks
to the drug companies and the insurance companies. Last information I
received, the pharmaceutical corporations, the major drug companies,
made over $50 billion in profit, but this legislation would throw
Americans off of health insurance to give drug companies even more
profit.
This legislation, the House bill--and, I think, similarly, the bill
being worked on behind closed doors--is not only opposed by the AARP,
which is the largest seniors group in America, but it is opposed by the
American Cancer Society, the American Heart Association, the American
Lung Association, the Cystic Fibrosis Foundation, the March of Dimes,
the National Multiple Sclerosis Society, and the American Medical
Association because the doctors know what a disaster this will be for
healthcare for millions of Americans--also, by the American Nurses
Association and the American Hospital Association. You have all of
these groups that are the pillars of healthcare in America saying: No,
no, this is a disastrous bill. Yet we have the Republican leadership
and a dozen or so Members who are working behind closed doors.
Nobody here has suggested that the Affordable Care Act should not be
improved. In my view, it should be improved. In my view, deductibles
are too high, copayments are too high, and premiums are too high.
Certainly, the fact that we are paying twice as much as any other
country for prescription drugs has to be dealt with also.
The task right now, among sensible people, is to put it on the table
and to be honest about it. What are the problems of the Affordable Care
Act? How do we lower deductibles? How do we lower copayments? How do we
control the escalating cost of healthcare?
Those are reasonable questions that honest people should debate, but
the answer is not to throw 23 million Americans off of health
insurance. That is not a solution to the problem. That is an insult to
the American people.
Let me just conclude by stating this. Our job right now is to make
sure that this disastrous Republican proposal never sees the light of
day. I would urge my Democratic colleagues, on behalf of the American
people--the vast majority of whom know how bad this legislation is--to
stand up and fight in an unprecedented way to make sure that that
legislation never sees the light of day.
After we win that struggle, I would hope that we would come forward
as a nation and join every other major country on Earth, whether it is
Canada--and I live 50 miles away from the
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Canadian border--the United Kingdom, France, or Germany--and say that
healthcare is a right of all people, not a privilege. If you are an
American, you are entitled to healthcare. You should not be one of the
23 million people thrown off of healthcare, bringing the total of
uninsured in America to over 50 million people. That is outrageous.
I think you are going to hear the American people stand up loudly and
clearly and demand transparency and demand serious debate on an issue
of this consequence. I think, at the end of the day, this legislation
will be defeated.
I yield the floor.
The PRESIDING OFFICER. The Senator from Washington.
Mrs. MURRAY. Mr. President, Democrats come to the floor this evening
as a voice for the people we represent, to fight back against
Republican plans to jam TrumpCare through this Senate, increase
healthcare costs, and hurt families across the country. Republican
leaders may hope that nobody pays attention. They can hope that they
can go into these secret rooms and cut secret deals and come out with a
TrumpCare bill that they can jam through before anybody notices.
We are not going to allow that to happen. We are here. We are going
to fight back. I can only hope that just a few Republicans will decide
to listen to their constituents, reverse course, and work with us to
improve healthcare instead of standing with President Trump to destroy
it.
I start by talking about a constituent of mine whose story I heard
and whose voice and perspective should be a part of this debate.
Her name is Lisa. She is from Spokane, which is in my home State of
Washington. Lisa served our country in the Navy for 6 years. She goes
to school. She works part time, and she says she relies on Medicaid to
afford the healthcare she needs. She is very worried that, if TrumpCare
passes, she will not only suffer from cuts to Medicaid, but she will
lose her coverage altogether because, like many Americans, she has a
preexisting condition--asthma.
Lisa is not alone. There are millions of people just like her in
Washington State and across this country, and each of them--every
patient, every family--has a stake in this fight. They deserve to be a
part of this debate, and they have a right to know how TrumpCare would
impact them if it is signed into law.
That should not be a partisan sentiment. I have heard Republicans
come to the floor time and again, demanding transparency, railing
against secrecy, calling for hearings. One Republican Senator who is
now the chairman of the Senate HELP Committee came here to the Senate
floor back in 2009 to blast Democrats for writing an amendment ``in
secret.'' He said: ``None of us on the Republican side knew what was in
it,'' and he accused Democrats of trying to pass our bill ``before the
American people find out what's in it.''
My friend, the chairman of the HELP Committee, is certainly not
alone. Back then, the current Republican majority leader said: ``This
massive piece of legislation that seeks to restructure one-sixth of our
economy is being written behind closed doors, without input from
anyone, in an effort to jam it past not only the Senate but the
American people.''
That was not true back then. We held dozens of bipartisan hearings
and meetings over months and months and months. But it is what
Republicans are doing right now.
The chairman of the Senate HELP Committee, whom I respect and would
never think would be a part of an effort like this, told me that he was
not planning to hold a single hearing on TrumpCare. The chairman of the
Senate Finance Committee, which is where a lot of work on this bill
should be getting done, told my friend the Senator from Missouri that
he was not going to hold a hearing either.
There are reports now that Republicans actually have the text of
their bill--something is written and almost ready. Democrats do not get
to see that bill. People across the country are being kept in the dark.
Republican leaders are treating it like President Trump's tax returns
and are not allowing it to see the light of day. It is absurd, and it
is unprecedented.
We could be just days away from a massive bill being jammed through
this Senate, and many Republican Senators are telling press and
constituents that they could not even say what was in the bill if they
wanted to because they have not seen it either. This bill is so secret
that even President Trump's top health adviser, the Secretary of Health
and Human Services, told us in a hearing last week that he has not seen
how TrumpCare is being changed in the back rooms of the Senate.
Let me ask this. Why are Republican leaders so focused on keeping
their TrumpCare work secret? Why are they keeping it locked down so
tight and not letting people see what is even in it? What are they so
ashamed of?
One Republican Senate aide was quoted as saying: ``We aren't
stupid.'' In other words, Republicans know it would be ``stupid'' to
put this bill in the public because they know that people across the
country--the people they are supposed to represent--would hate it.
That explains a lot.
Republican leaders--those who are writing this TrumpCare bill in
secret--know that they would not be able to go back home and defend it.
They know that the more people who learn about what is actually in it
and what the fine print might mean for them and their families the more
people back home are going to rise up and fight back. So they want to
keep it wrapped up tight, under lock and key--no hearings, no scrutiny,
no public input. When they first announced their secret working group,
not even any women were in it. Republican leaders are in their back
rooms, desperately trying to cut those final deals, doing whatever they
can to bully those last few Republicans into supporting something they
know their constituents will hate.
We are here tonight to say that enough is enough. This has to end.
Healthcare is too important, and TrumpCare would be too devastating to
allow this kind of secrecy to continue.
We do not know exactly what is in the TrumpCare bill that is being
written in secret, but--do you know what?--we have a pretty good idea.
No matter how much lipstick they put on this pig, based on everything
we have heard, this is going the same way that TrumpCare went in the
House, and the impact on patients and families would be just as bad.
There would be higher costs for families, especially seniors and people
with preexisting conditions. Insurance companies would no longer be
required to cover basic healthcare--things like maternity care or
mental health services, and much more. Women would lose access to see
their doctors and the care they need at Planned Parenthood, and
millions of people across the country would see their Medicaid coverage
taken away.
That means that, nationwide, people who are finally getting treatment
for substance use disorders, like opioid addiction, or mental
healthcare or access to a primary care doctor under Medicaid are going
to lose that access.
This would be so devastating for families across the country. Over
the past year, I have had so many families in my home State who have
lost a loved one to the opioid crisis. In Bellingham, in Spokane--in
community after community--the story is always the same. I have heard
directly from people on the path to recovery, like Tyler in Yakima and
Mechele in the Tri-Cities, who told me how getting treatment changed
their lives for the better.
I could not imagine that any Senator would want to go home, look in
his constituents' eyes, and tell them that he helped pass a bill that
would take away the tools that those communities need to fight this
crisis, but that is what my Republican colleagues are planning to do as
we speak.
Let's remember that all of this damage would be done--why?--to give a
massive tax break to special interests in the health industry and to
hand President Trump a hollow political win. It is truly shameful and
it needs to stop.
Last week, we learned that President Trump is now saying that the
House bill is ``mean.'' That is, certainly, an understatement from a
President who does not often do subtlety, and it is pretty surprising
to hear after we all saw him celebrate the House bill at the White
House when it passed.
Here is the truth: The House TrumpCare bill is not just mean; it is
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devastating. The Senate TrumpCare bill is going to be just as bad, no
matter how they try to spin it or how many side deals they cut to claim
it has changed.
I have a message for Senate Republicans who are so ashamed of what is
in this bill that they are keeping it secret: It is not too late to
change course. It is not too late to bring this process out from the
shadows. It is not too late to be honest with people across the country
about what you are doing. It is not too late to listen to the voices of
people like Lisa. It is not too late to abandon this plan to jam
TrumpCare through Congress. If you do that, if you stop, Democrats
stand ready, as we always have, to work with you to actually make
healthcare more affordable and accessible for patients and families
across the country.
People across the country are watching. They are paying attention to
this. They are not going to allow Republicans to slip this through
without any scrutiny, and we Democrats are here to say, loud and clear,
that we are going to keep fighting to make sure they have a voice.
I yield the floor.
The PRESIDING OFFICER. The Senator from Connecticut.
Mr. BLUMENTHAL. Mr. President, I am proud to join my colleagues
tonight because this Nation stands at a precipice--on the verge of a
tragic mistake, about to embark on a travesty that mocks the democratic
process. Truly, the combination of secrecy and speed are a toxic recipe
in our democracy. Secrecy and speed will bring us recklessly over the
edge of that precipice to tragic mistakes that belie and betray the
people of America and the values that we all share in this Chamber,
because they are basic to the American way of life.
Healthcare is a right, and it should be recognized as a right. The
goal of extensive and comprehensive insurance coverage has to be,
ultimately, a goal that we share in common, but, right now, we are
speeding secretly toward a betrayal of American values and even of our
constitutional duties. I am deeply disappointed that the secrecy
employed by my colleagues has brought us, recklessly and reprehensibly,
to the verge of gutting the Affordable Care Act.
The absence of hearings before the committee, the absence of public
debate, the absence of any text of a bill that can be debated and
offered for public comment leaves us without the democratic bedrock
principle of listening to the people of America and listening to the
people who are most affected, who know the most--the experts and the
patients. In fact, it is the patients who deserve to be heard here
perhaps most of all. Yet my colleagues on the other side of the aisle
seemingly will go to any length to suppress the cruelty that lies in
their alleged healthcare bill. President Trump has called it mean, and
that is an understatement. It is cruel beyond words and costly in lives
and in dollars and cents because it will deepen and worsen healthcare
issues that can be prevented and made curable or more palatable.
Let's be clear. This secrecy--a small group of men making decisions
about our entire healthcare system, with no input from women, from
Medicaid beneficiaries, from people with substance use disorders, from
patients struggling with mental health illness, or struggling with any
disease at all--is irresponsible and deadly and truly cruel and costly
to our democracy.
The way these discussions have been done are a stain on this body and
a slap in the face to every American who relies on us to make decisions
that are in the best interests of their family as well as themselves.
My colleagues seemingly would prefer to ram and rush a deeply flawed
and unpopular bill through this body, ignoring the needs and will of
the people they represent. That is a sad day in this Chamber.
We need public hearings, not for their own sake, not for our sake but
for the individual recovering from substance use disorder thanks to
Medicaid; for the mother of a little girl with a preexisting condition,
terrified of how she will pay for her care and able to do so now
because of the Affordable Care Act; for the woman who is at a Planned
Parenthood clinic today receiving a mammogram and other cancer
screenings and other preventive healthcare testing, as well as men,
because of the coverage provided to them by Medicaid and the Affordable
Care Act. Defunding Planned Parenthood, risking, again, preexisting
conditions, eliminating the guarantee of essential health benefits,
such as maternity care, is a war on women's healthcare and a disservice
to our democracy done in secrecy.
My colleagues across the aisle may succeed in gutting our Nation's
healthcare system, but the people who pay the highest price will be
ordinary Americans, working men and women and their families who now
have healthcare coverage to prevent more serious illness and who will
now go without it.
Secrecy is the reason I convened an emergency field hearing on
healthcare today in Connecticut, on very short notice--literally 24, 48
hours--and people came from across Connecticut at 9 a.m. on a Monday
morning. My staff did yeoman's work putting together the logistics. The
outpouring of anxiety and anger was remarkable, as was the eloquence
and power of the insights offered by people about their own situations
as well as about others whose interests they advocate. Many decided to
stay and stand, even though the room afforded inadequate numbers of
seats for everyone. It was standing room only, and they literally
streamed out the door. The stories they told are worth hearing, and we
have an obligation to listen to these Americans.
I told them I would personally bring their voices and their faces to
this Chamber, to the floor of the U.S. Senate. In the coming days, that
is exactly what I will do because people need to hear the story of a
beautiful young woman who now is incapacitated because she suffered
from an overdose after seeking treatment, and the effect on others
similarly seeking treatment will be so dire and damaging if coverage
for addiction treatment and abuse treatment is eliminated.
They need to hear the story of Sean, who similarly sought to overcome
a substance abuse problem. They need to hear about individuals who
would suffer from preexisting conditions. Those stories are what I will
be recounting in the coming days, as I share word for word their fears,
their anxiety and apprehension, and their worry for America about what
will happen if the Affordable Care Act is repealed and gutted.
We must build on that act. We must improve its defects and make sure
it is worthy of the great goals we share but not destroy it or decimate
it, and building on it, acting constructively, coming together is what
we owe the American people.
The folks who came today to the State capitol in Hartford at my
emergency healthcare hearing recognized that if they fail to stand up
for Planned Parenthood or mental health or those people with
preexisting conditions or Medicaid or their loved one who is battling a
dreadful disease, no one will.
I am so proud of them and the people of Connecticut who have spoken
up and stood up for the Affordable Care Act, and I am proud to bring
their voices to the U.S. Senate--literally bring their voices here, as
I will do over the coming days, as I read into the Record and put in
the Record their testimony. I will hold a second hearing, probably
later this week, because we couldn't hear from everyone who came to
speak out and stand up.
I hope my Republican colleagues will stop their denial, cease
ignoring and disregarding those voices, and come to listen to them
instead and recognize they cannot conceal the fact that the Affordable
Care Act has helped our Nation's health.
Gutting it without any hearings or public debate is unconscionable
and reprehensible. It is a move they will regret. I stand ready to
build on the great strides made by the Affordable Care Act, and I hope
my colleagues are ready to do the same.
If this Chamber proceeds down this reckless and reprehensible path of
secrecy and speed toward repeal and gutting the Affordable Care Act, I
promise to do everything in my power and use every tool at our disposal
to stop this process. We cannot go about normal business in the U.S.
Senate while so many back in our States demand that we fight, and we
must fight.
I will stand with hundreds of thousands in Connecticut who will lose
their insurance--more than 220,000. I
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will stand with the people of Connecticut who will lose billions of
dollars in investment in healthcare. I will stand with more than 20,000
people in Connecticut and 1 million around the country who will lose
jobs. According to a study recently done by the Commonwealth Fund, job
losses are inevitably the result, at some point in the future, of
gutting this program. I will stand with the people of America and my
colleagues who will resist--indeed, resist--this secrecy and speed that
so disserves the values and betrays the ethos and traditions of this
body.
I yield the floor.
The PRESIDING OFFICER. The Senator from Washington.
Ms. CANTWELL. Mr. President, I come to the floor tonight to join my
colleagues to raise concern about a proposed Senate healthcare bill
that might move through the U.S. Senate, as my colleagues are pointing
out, without a hearing, without attention to details, actually almost
in secret. I guess it would be secret--if we didn't know exactly what
was in the House bill, it would be even more secret. People have said
it is probably going to be 80 percent of what is in the House bill.
I can tell you, I agree with President Trump. That was a mean bill.
So if it is just 80 percent mean, I guarantee it is still going to be
mean.
I say that because I have been at home listening to my constituents,
and they do not appreciate it one bit. If you are Harborview Medical
Center and you are a public hospital and you are going to cut $627
million out of their budget because of your cap on Medicaid and you are
going to leave a regional hospital without resources, they are mad.
If you are talking about children's hospitals and they see children
who are on Medicaid and they are not going to be able to see those
children or get coverage, they are mad.
Just Saturday I was with veterans in Vancouver, WA. People don't
understand, but veterans of the United States of America do not get all
of their healthcare coverage through the VA. They get it with Medicaid
at individual clinics for services. I have met several of these people
in my State, and they have told me point-blank, without access to
Medicaid, they would not get the benefits they need as veterans of our
country.
I think it is mean to break our promise to veterans and not give them
access to Medicaid. I think this whole discussion is basically the fact
that we are trying to box with these guys on a proposal. If their
proposal is so great, they should come to the Senate floor and just--
don't even talk about the bill, talk about the principles.
I want to know, in the Republican proposal, what ideas do you have to
lower costs, increase the quality of care, or improve access. Those are
the milestones by which you should be debating healthcare.
Now, if your goal is to just cut Medicaid and cut people off Medicaid
and cut their benefits so you can give tax breaks to the rich, OK, you
might convince me that, yes, you have a proposal--because I think that
is exactly what their proposal is--but if your proposal is about
reducing costs, then come out here and debate it. Don't even tell me
what is in the bill; just show up on the Senate floor and debate us and
say: Here is our idea for reducing costs.
I will tell you what my idea of reducing costs is because I wrote it
into the Affordable Care Act and some States are doing it and it was a
good idea. It was called give the individual who doesn't work for a big
employer the ability to negotiate with clout and be bundled up with
other people. That is what they did for the working poor in New York.
So 650,000 people in New York are now on something called the Basic
Health Program. Why? Because they didn't work for an employer that
could negotiate a big discount for them.
We asked, on our side of the aisle: Why would we let poor people just
get thrown around in the market and not be able to drive a decent
price? I call it the Costco model. So we said to them: We are going to
let you be bundled up like the big employer is and you are going to be
able to drive a decent price in the marketplace. That plan is giving a
family, with $40,000 a year of income and four individuals in the
family, a yearly annual premium of about $500 instead of $1,500 on the
exchange.
So that is an idea. So come out here and discuss that or, if you want
to tell me you have figured out a way to give better quality of care, I
would love to hear that idea. I would love for you to come out and tell
me how you are going to deliver better quality of care because I can
tell you there are things in this bill that are about quality of care.
They are about improving the way that organizations deliver care so
they are rewarded for achieving better outcomes for patients.
The whole idea of accountable care organizations are that you put the
patient at the center of the delivery system, and you reward them for
doing a good job of delivering better outcomes. We have innovated. We
have innovated in the Affordable Care Act. If you are talking about
access, come out and tell us what proposal you have that is about
increasing the access to healthcare. I would love to hear it because in
the Affordable Care Act, we already did that too. We said: You know
what. It is kind of crazy and expensive to think that everybody who
ages, particularly in Medicaid, should spend time in a nursing home.
Why? It is more expensive, and I don't think I have met one
Washingtonian who told me they really wanted to go to a nursing home.
They want to stay at home.
So we wrote into the Affordable Care Act incentives for States to
change the delivery system, as we have done in the State of Washington,
and deliver affordable care to people at home in their communities. By
gosh, actually some States--Texas, Arizona, Indiana, other States--took
us up on it. They said: What a great idea. We want to reduce costs.
So if that is such a great working aspect of the Affordable Care Act
and you think it works and it increases access to care by giving people
community-based care and reduces Medicaid costs, come out here and talk
about it. Talk about what you want to do to put that program on
steroids so more people in America can benefit from better access to
care and not think they are going to spend their last days in a nursing
home. That is what we should be debating. But we can't even see or hear
or have a hearing about what this proposal is. Yet my colleagues can't
even come out here and throw a concept on the table.
But the fact that you want to affect over 1 million veterans who have
fought for our country and you are going to cut many of them off of the
Medicaid care they deserve to have access to--that is a broken promise.
It is just as broken a promise as what President Trump said. President
Trump tweeted: I was the first and only GOP candidate to state that
there will be no cuts to Social Security, Medicare, and Medicaid. So I
am not surprised that he calls it a mean bill. But he should also own
up that it cuts Medicaid.
We all have an office budget. I see my colleague from Virginia here.
If we took our office budget and said: We are going to cut it and cap
it, and next year it is going to be lower, and next year it is going to
be lower, and next year--in perpetuity--that is what their idea is, it
is to put a cap on Medicaid and cut it in perpetuity and basically cut
it out of existence.
I don't know why they are beating up on Medicaid, because Medicaid
has provided great stability to so many people in our country. It has
lifted people out of poverty, provided healthcare, stabilized
communities, and raised the economic standard of living in many
communities in our country.
I received a letter from a superintendent from the Vancouver School
District. He wrote to me about the devastating impacts that capping
Medicaid would have on his students. He wrote:
Our school-based Medicaid programs serve as a lifeline to
children who can't access critical healthcare and services
outside of their school.
He goes on to say:
Restructuring Medicaid to a per capita cap system would
undermine Vancouver Public Schools' ability to provide
America's neediest children access to vital healthcare
[insurance].
So why would we do this?
I met a veteran, Kristina, who is 46 years old and a full-time
student. She suffers from chronic and disabling injuries and needs a
high level of care. The care she gets from Medicaid helps her access
the medication that manages her chronic care and keeps her going,
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and she is working toward that degree. Why would we cut somebody like
that--a veteran--off of Medicaid just because someone's idea over here
is to cap and reduce Medicaid?
These stories are from all over the country, and people are
wondering: Why would you take this level of investment in Medicaid out
of our entire economic system? Why would you impact our school
districts, our regional hospitals, our veterans, our Medicaid
population? Why would you affect a community that has a large Medicaid
base?
And that is the way they serve them. Our hospitals have told us: We
have stabilized private insurance premiums because more of the
population is covered and has access to Medicaid.
You rip that back, and we will be back to skyrocketing costs, with
people in the emergency room, no access to care other than that
facility, with impacts on everybody on private insurance and on
Medicaid. It is just not a good idea.
So I ask my colleagues, come out here. Don't say you want a patient-
centered healthcare delivery system, because we are all for that, and
we actually put things in the Affordable Care Act that did that and are
working. If you want to make that claim, come out here and say what it
is that you don't like about the patient-centered delivery system that
we are working on promoting, and how you want to change it. If you say
your proposal increases access to Americans, let's hear it, if it is
about better quality. But I don't hear any of that. I just hear a
drumbeat by some people who want to be heartless and cut people who
have access to healthcare, people who are less fortunate in our
society, because they want to cut Medicaid.
The President promised he wasn't going to do that. I ask my
colleagues to live up to that, and let's start talking about the
substance that truly will increase access, lower costs, and give better
care to our constituents and the people of the United States of
America.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Virginia.
Mr. KAINE. Mr. President, I also rise to talk about the healthcare of
every American. This is critically important to every person and every
family in this country. It is critically important to every local,
State, and Federal budget in this country. It is also critical to the
economic productivity of our Nation.
In a purely partisan move, the House barely passed a bill that would
take health insurance away from 23 million American people over the
next 10 years, dramatically increase premiums to seniors, jeopardize
coverage of people with preexisting conditions, and impose huge burdens
on States.
One of the reasons the House bill was so bad--condemned even by
President Trump, who labeled it ``mean''--was because it flowed from a
bad process. The House held no hearings on the final bill. There was no
meaningful testimony from patients or healthcare providers. They did
not accept any amendments from Democrats. They rushed the bill through
to vote before the Congressional Budget Office could score the bill. So
no wonder. No wonder the House bill is opposed by the American Medical
Association, the AARP, nurses, hospitals, patient organizations,
Democratic and Republican Governors. Yet the Senate is poised to make
exactly the same mistake--preparing a secret bill, with no testimony,
no public scrutiny, no opportunity for meaningful amendments, no
opportunity for Democrats to participate.
We have the opportunity to get this right, and we have the
responsibility to get this right.
There are so many problems with the House bill. As a member of the
HELP Committee, I went on Friday to the Culpeper Free Clinic about 75
miles from here to talk about the need for real improvement in our
healthcare system, not a repeal that would hurt vulnerable people. At
this clinic, which is celebrating its 25th year, I saw dedicated
staffers and volunteers, and I talked to patients. I talked to them
about how this organization has provided compassionate care to working
people in this region of Northern Virginia who don't have health
insurance.
The fact that Virginia has refused to expand Medicaid is one of the
reasons the need for their care is so significant. Fully 70 percent of
the free clinic patients in Virginia would be eligible for Medicaid if
the State would just join the 35 other States that have expanded
Medicaid.
What I heard at the Culpeper Free Clinic is that they are already
bursting at the seams because we haven't expanded Medicaid.
If there are additional cuts to Medicaid, it would overwhelm the
ability of the 60 free clinics in Virginia to provide compassionate
care.
Just a few hours ago, earlier today, I went to Albemarle County near
Charlottesville and had a roundtable session with educators, families,
and children's advocates to highlight another key problem with the
Republican approach. By dramatically cutting Medicaid, who is the most
likely victim? Children. The most numerous victims of Medicaid cuts are
children.
In Virginia and nationally, nearly 60 percent of the recipients of
Medicaid are kids. Yet the President, through the TrumpCare bill and
the President's submitted budget, proposes to cut Medicaid by $1.3
trillion over the next 10 years--$1.3 trillion over the next 10 years--
and this deeply frightens parents, educators, and kids I talked to
today.
I heard from parents of kids with cerebral palsy and autism, parents
whose kids are receiving support through Medicaid to buy a wheelchair
or get services so they can learn to adjust with autism. This will help
them grow into adults who have a chance of living independently. These
parents had heartbreaking stories, often telling me: I had no idea of
the challenges of parenting a disabled child until I had one myself.
They view Medicaid as absolutely critical to their children's
educational and life success.
They talked about the current shortfalls in the Medicaid funding that
leave their kids on waiting lists for services. One mom has been on a
waiting list for a developmental disability waiver. I asked her what
they told her about the waiting list, and this was her quote: ``They
have told me my child will die before he is off the waiting list.'' And
that is under the current program, before $1.3 trillion is cut out of
it.
I heard from school administrators who talked about the importance of
Medicaid funding for their programs that serve students and special ed
teachers who are worried about the effect on their work if Medicaid is
slashed.
Local superintendents and school board members talked about the
difficult challenges of funding their school budget if Medicaid funding
is cut. They posed it as a difficult choice. If the Feds cut $1.3
trillion out of Medicaid, do they reduce their funding for their
students with disabilities, or do they take local funds away from other
important programs to backstop those programs, or do they have to raise
their own State and local taxes to make up for the Federal cuts?
I heard from child service advocates today who would see their
program slashed if Medicaid is cut. Here is an example. Many of them
serve court-involved young people--not kids charged with crime but kids
who are in court because of difficult home lives and challenging
situations with their parents or guardian, and they are in danger of
being pushed into the foster care system or into institutions because
of problems at home. Medicaid pays for support services to help
stabilize their family lives. If these services are reduced and more
children get institutionalized, how does that help anyone? How does it
help these kids? How does it help society? How does it help our budget?
It is much more expensive to put a child in a group home or an
institution than to provide a few hours of Medicaid services in their
home once a week.
The 60 percent of Virginia Medicaid recipients who are children and
the parents and teachers and nurses and others who worry about them and
help them don't see this as a partisan issue. It is fundamentally an
issue of compassion. We will and should be judged by how we treat our
children. Why slash funds that are used to help our kids? Is it really
important to cut Medicaid by $1.3 trillion, hurting millions of
children, so we can give a few adults a $900 billion tax cut?
I am on the Budget Committee. We had a hearing recently with OMB
Director Mulvaney, within the last 2
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weeks. Director Mulvaney tried to reassure us in his opening statement
that the Medicaid cuts were really about doing people a favor--about
doing people a favor. He testified: We are no longer going to measure
compassion by the number of programs or the number of people on
programs like Medicaid; we are going to measure compassion by the
number of people we get off these programs and back in charge of their
own lives.
I want to repeat that, from the President's chief budget official: We
are going to measure compassion by the number of people we get off
these programs and back in charge of their own lives. What a cruel
thought. That reads like something a villain in a novel by Charles
Dickens would say, but that is the philosophy of this administration
and this effort. Will we now tell a kid who loses the wheelchair that
is partly paid for by Medicaid ``You are now back in charge of your own
life''? Will we tell a single mom whose child is receiving services to
help with autism but now loses access to these services ``Guess what.
You are back in charge of your own life''? Will we tell a teenager in a
broken home whose Medicaid services are the only difference between
staying in the community and being put in an institution ``Guess what.
You are now back in charge of your own life''?
Since Medicaid also provides funding for our parents and grandparents
who can no longer care for themselves and have to be cared for in
nursing homes, will we go to those seniors who lose places in nursing
homes and say ``Guess what. Now you are back in charge of your own
life''?
Slashing Medicaid isn't about putting anyone back in charge of their
own life. Medicaid enables kids to go to school and succeed. Medicaid
enables disabled people to function well enough to go to work and pay
taxes. Medicaid enables seniors to receive compassionate care when they
can't care for themselves, and cutting Medicaid jeopardizes the ability
of people to live with independence and dignity.
No, folks, let's not kid ourselves. This is not an effort to empower
anyone. It is about casting them aside because they are too young or
too old or too sick or too poor, and it is about giving a tax break to
some people with the very funds we are taking away from the most
vulnerable members of our society.
That is why I oppose this ``mean'' effort by the majority as a
secretly crafted bill to repeal the ACA. We can improve healthcare if
we work together. Let the Finance and the HELP Committees discuss any
bill, hear from patients and providers, allow amendments and debates
before rushing anything to a vote that would so cruelly affect the
lives of millions and millions of people.
With that, Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Massachusetts.
Ms. WARREN. Mr. President, I get letters and emails every day from
families begging me not to let Republicans in Congress tear up
healthcare in this country. People aren't writing because they find
themselves with a lot of extra time on their hands. They are not
writing because they are professional activists or political
organizers. They are not writing because they like writing letters and
emails. They are writing because they are scared. They set aside all
the other things they need to do in their day--the sink full of dishes,
the load of laundry, the overflowing inbox--and they steal some time to
write these letters.
They write these letters because they are terrified--terrified down
to their bones that if they don't speak out, their family is going to
lose their healthcare coverage, their children will be shut out from
care, their elderly parents will lose the assistance they need to pay
for nursing home care, their own insurance costs will be going up, and
their financial security could be hanging by a thread.
A lot of people write letters and send emails, and a lot of people
make calls too. Every week since the Republicans started their cruel
effort to take away healthcare from tens of millions of people in this
country, my office has been getting phone calls from worried
constituents.
Last week, something changed. We went from our regular quota of calls
about this terrible Republican healthcare bill to an avalanche of voice
mails and phones ringing off the hook.
Since last week, I have gotten more than a thousand phone calls from
people who are pleading with me to do whatever I can to stop
Republicans who are going forward with their brutal plans. People are
literally in tears on the phone. They are scared, and they are angry.
They are calling because they know that 13 Senate Republicans--13 men--
are locked away in a secret room, behind closed doors, writing a secret
plan to trade their health insurance for tax cuts that will go to the
wealthiest Americans in this country.
The bill the Republicans are negotiating behind closed doors isn't a
healthcare bill. It is a tax cut for billionaires bill, and it is paid
for by cutting healthcare for tens of millions of other Americans.
The Republican healthcare bill has $663 billion in tax cuts in it--
$663 billion in tax cuts for the richest people in this country and for
wealthy corporations, tax cuts that would blow a giant hole in the
American budget.
The Republicans didn't let that slow them down. They kept their eye
on the prize. For the Republicans, the most important thing about this
healthcare bill is the tax cuts for the rich. They decided to cut
Medicaid by $834 billion in the same bill so they can pay for their tax
cuts.
This is a straight-up trade. The Senate Republicans say that
Americans should cut health insurance for little babies or for seniors
in nursing homes or for people getting treatment for opioid addiction--
all so that millionaires and billionaires can get their tax cuts.
That is not a healthcare bill. That is a statement of values. And it
says that tax cuts for a handful of millionaires and billionaires are
more important than healthcare for millions of hard-working Americans
and their families. There is only one word for what the Senate
Republicans are doing with this bill--``shameful.'' It is shameful.
The Republicans negotiate in secret, behind closed doors. They refuse
to let anyone see the bill. They will not tell anyone what is in it.
Senator McCaskill asked Chairman Hatch on the Finance Committee if he
would hold a hearing on the bill, and he said no. Senator Murray asked
Chairman Alexander on the HELP Committee if he would hold a hearing on
the bill, and he said no, no plans to do so--no, no hearings, no
reviews, no public look at what the Republicans are up to.
What is going on here? I will tell you what is going on. Senate
Republicans don't dare let the people back home see this bill. They
don't dare let voters see this bill. Instead, they have decided to try
to ram this bill through with no hearings, no public discussion, and
get it signed into law.
They hope, once that is done, people will not see much point in
learning about the details and holding Republicans accountable. They
hope that if they can do a quick vote, everyone else will just give up.
I have news for Senate Republicans. That is not going to happen.
Senate Republicans may not want to hear from families who are worried
about losing their insurance coverage in the middle of a battle with
breast cancer. They may not have time for stories about premature
babies who need Medicaid so they can get lifesaving care. And maybe
they don't want to hear about the grandparents with Alzheimer's who
could get kicked out of nursing homes.
Senate Republicans may not want to hear from these people, but I have
a message for these Senate Republicans. We don't care how long we have
to stand up here. We don't care how many times you try to dodge the
question about what is in your secret healthcare bill. Democrats are
here to keep demanding that you show us this bill, and we are going to
keep insisting that you account for its shameful contents.
I know you would prefer to take the phone off the hook so you don't
have to hear it ring, and I know you would like to pretend that there
aren't families in your State who would be hurt by this bill, but I am
going to take some time to read you a handful of the letters I have
been receiving about exactly what is at stake in this debate about
healthcare. These families deserve to be heard.
[[Page S3592]]
A few months ago I received a letter from Jenny in Worthington, MA.
She wrote to me about how she and her husband got good healthcare
coverage through the Affordable Care Act and how Medicaid was there
when they needed it most, when Jenny was diagnosed with breast cancer.
A few days after President Trump's inauguration, Jenny's son Liam
wrote a letter to the President. Liam asked President Trump not to take
away his mother's healthcare. I don't know if President Trump ever read
that letter, but I am going to read it right now into the Congressional
Record.
Dear President Trump,
My name is Liam Barry, and I am ten years old. My mother
has been very ill. Thanks to the ACA, my mother has been able
to have the care and medication she needs. If you repeal the
ACA, my mother will not be able to get the care she needs. I
know there are millions of kids in the same situation as me.
Please think of them when you read this.
Sincerely,
Liam Barry
Thank you for speaking out, Liam. We are fighting for your mom, and
we are fighting for you.
Kristine from Cambridge also wrote to me about her fight against
cancer. She wrote:
I ask that you and fellow Senators PLEASE fight for the
Affordable Care Act. I am a cancer survivor. When I was 28
years old, I got the news no one ever wants to hear, ``You
have cancer.'' Luckily, for me, I had a job that had
wonderful insurance, and I was able to get medication,
surgeries, and treatment to win the fight--and to not go
broke doing so.
However, I know many young people and old people and
children who would not be here today if it was not for ACA. I
know people who are still fighting their battles with cancer.
They are frightened and losing hope, not because of cancer,
but because they don't know whether they will be able to
continue to get the treatments necessary to stay in the
fight.
I am now 30 years old, and have my whole life in front of
me. Because of what [President] Trump is proposing, I am now
afraid that if I lose my job or if I wish to change jobs, I
might not be able to get the necessary coverage, because I no
longer qualify.
I really didn't think this is what I would be worried about
two years ago after having been through 8 rounds of chemo, 20
rounds of radiation and surgery to clear me of this disease.
Please, I ask that you fight for us. Fight for those who
are in the chemo chair right now, at this very moment, who
are miserable, bald and bloated. Fight for the cancer warrior
who is now crying with worry because she doesn't know, come a
month from now, if she will be able to continue to receive
the life-saving treatment she is entitled to!
That is why we are here tonight. We are fighting for you, Kristine.
We are in this fight. Thank you for speaking out about your own fight
against cancer and for others who are currently battling cancer and
worried about the future of their healthcare.
I also heard from Sarah, who lives in Shrewsbury, MA, and who wrote
to me about her concerns that the Republican healthcare bill would
endanger coverage of birth control and access to services at Planned
Parenthood. Sarah wrote to me this past weekend, while I was out
dancing in the Boston Pride parade.
As I type this you are at Boston Pride, which I would have
loved to be at to support my friends, but, due to my
endometriosis pain, here I sit.
I am extremely concerned about the GOP plan to reduce or
strip away insurance coverage for birth control. As a 21-
year-old woman suffering from endometriosis, a very common
disease among young women, I know firsthand that birth
control does more than just prevent pregnancy--in fact, for
many, it is the only treatment for them.
In 10 days I will be undergoing endometriosis surgery, and
for the past 6 months since I've been diagnosed until the
surgery, birth control was the only thing enabling me to
stand up straight most days. Even while taking oral
contraceptives, there were many days I was unable to get out
of bed (today being one).
I am so lucky to have access to an amazing endo specialist
at Brigham & Women's Hospital, and to have access to the
medication and surgery that I need. But every time I groan
about having to go to an appointment, I think about how many
women are suffering from the same debilitating pain, but
without the resources to overcome it. Many women rely on
Planned Parenthood not just for abortions, but to provide
them with the medicine that will enable them to stand up
straight in spite of the pain they deal with every day.
Endometriosis doesn't discriminate, and it cannot be cured,
only treated. Until endometriosis becomes a prominent focus
of medical research, which I feel it should be, we must
protect the right to be treated for it, which means
protecting insurance coverage of birth control, and
protecting Planned Parenthood.
I know that you are a warrior for women's rights, and you
are the patron saint of Planned Parenthood. I know these are
issues you fight for, and I cannot even begin to thank you
enough for all you have done thus far. I hope that by adding
my voice and my personal story, I can fuel your fire and
somehow be a small part in protecting my fellow females and
my fellow endometriosis sufferers (1 in 10 women in the US).
Thank you for fighting for us. Thank you from the bottom of
my heart.
Sarah, thank you for writing, and thank you for fighting. We are
going to fight to save your coverage, and next year I expect to see you
on the parade route at Pride.
I also heard from Dr. Hemal Sampat, who is a doctor at MGH in Boston.
He wrote in with his personal story, and I want to read parts of his
letter.
I actually grew up in a low-income family myself. My
parents immigrated to the U.S. My mother is brilliant but
only had a 7th grade education because my grandfather
couldn't afford to send her to school. My father is college-
educated, but struggled frequently with unemployment. My
older brother has multiple disabilities. He's blind and
brain-damaged from a stroke during childhood, epileptic,
intellectually disabled, and has a transplanted kidney. I am
fortunate enough to have been healthy my entire life.
For most of my life, my family was on Medicaid, as well as
other forms of public assistance. . . . My brother,
additionally, due to his kidney disease, got Medicare as
well, but Medicaid was always his secondary insurance. He
sees multiple different specialists and has done very well
over these years.
In spite of us having multiple financial struggles, we
never had to worry about his healthcare being paid for. His
transplant from childhood lasted 19 years, and then about 10
years ago he was transplanted again and has done well with
that.
My parents still live in the same house I grew up in, in
Maryland. Right now, they're cared for by Medicare and
Medicaid. My brother lives with them, receives SSI, and his
health needs are met by Medicare and Medicaid. Although none
of his chronic medical conditions can be cured, they are all
well taken care of.
In the meantime, I grew up healthy, was able to attend
Georgetown through need-based financial aid, was able to get
into medical school at the University of Maryland and pay for
it using Federal student loans (which I'm repaying through
the Public Service Loan Forgiveness program), got into a
dual-specialty residency of Internal Medicine and Pediatrics
at Penn State, and am now working at Harvard and MGH.
My family's story goes to show that Medicaid is about
helping families that struggle, about helping children with
complex medical needs, and about how providing for the good
health of a family can achieve positive outcomes for the
long-term future.
Today, Dr. Sampat works at Harvard at MGH. He makes sure his patients
on Medicaid get excellent care. He told me about one of his patients
who came in to urgent care in Chelsea. This little girl wasn't even 2
years old yet and was wheezing and had a fever. Here is what the doctor
said:
This child and her mother were on Medicaid through
MassHealth. [As] I asked questions, I found out more about
this mother. She was working two to three jobs in order to
make ends meet. Her daughter was in daycare during the day
and then [the] grandmother took care of [the little girl]
most evenings. This mom took care of her daughter on the rare
days she had off and clearly loved and cared for her
daughter.
This young girl's wheezing was probably some of the
earliest signs of what will become asthma. [Her] mom has
asthma, too, and it runs in their family. Asthma is a
completely controllable illness with medication, but it
requires monitoring by a doctor and access to medication.
Because the child has Medicaid, I feel much more confident
that, in spite of how much the mother is struggling
financially, the child has a good shot at growing up healthy.
Without Medicaid, this child could live a life in poor health
from a treatable condition.
These are some of the people the Senate Republicans want to kick to
the curb so they can deliver a big tax cut for millionaires and
billionaires--a 10-year-old kid with a sick mom, a cancer survivor, a
woman with endometriosis, a boy kept healthy by Medicaid so he could
grow up to become a doctor at one of the best hospitals in this country
and help a little girl with asthma.
Senate Republicans are willing to tear away health insurance from
these families to deliver tax cuts for their buddies, but we are not
going to let that happen. We can't let that happen. You are fighting
back, we are fighting back, and we will keep right on fighting.
I yield the floor.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. CASEY. Mr. President, I will start tonight with one of the
questions
[[Page S3593]]
that we have, and this will be a procedural question. I want to alert
the Chair, I am going to pose this question initially before I make my
remarks about the debate we are having on healthcare.
Is the Chair able to confirm that the Committee on Finance considered
S. 1796, the America's Healthy Future Act, which was ultimately
incorporated into H.R. 3590, the Patient Protection and Affordable Care
Act, in executive session on eight separate calendar days prior to
reporting the bill favorably?
The PRESIDING OFFICER. The Secretary of the Senate's office, through
the Senate Library, confirms that.
Mr. CASEY. Thank you.
Mr. President, I rise tonight to provide some context about what is
at stake for children in the United States with regard to the debate we
are having on healthcare and, in particular, what would happen--some of
the adverse impacts on children with disabilities.
I will start with the broad view, but I think it is important to
frame our discussions. Sometimes our debate on healthcare comes down to
a discussion of big numbers. How many people will be impacted? For
example, the Congressional Budget Office told us that 23 million people
would lose their healthcare coverage over the course of a decade if the
House bill were to become law. So healthcare coverage would be ripped
away from 23 million people or we hear about the impact on the deficit
one way or the other or we hear about broad numbers. Probably the best
way to think about the impact of these policies is, if the House bill
were to become law or some version of it because of what a few Senate
Republicans are working on right now--maybe the better way to think
about it is in terms of a couple of individuals, children.
I will give you two examples for now. Angelica and Rowan--two
different children, two different stories. We received a letter in the
last couple--I am sorry. Angelica is the parent. I should have said
Amaya. Amaya is the child whom her mom wrote to us about. Her mom is
Angelica.
She wrote to us and said:
I am writing to you because I am appalled by all that is
happening to this country. I have an amazing story about my
daughter Amaya. She was basically born with no bones and she
received a miracle drug that regrew her bones. She will have
to take this medicine for the rest of her life but the fact
that she is doing so amazing has to do with all the help that
she received from Medicaid. She is the youngest patient in
the U.S. to take the drug. I don't only want to talk about
her but I am concerned about the future of our party. Looking
forward to hearing from you.
So said Angelica. Then, later on, she talks about what happened in
her case to her child. She says she decided with a counselor to check
with the Allegheny County officials about whether or not Medicaid
expansion would cover Amaya's treatment. She said they made an inquiry.
She said by the next day, ``Someone from the State had called me, and
later that week her treatment was approved. Thanks to the Medicaid
expansion, my daughter receives her lifesaving treatment.''
So I make that reference to one letter about one child, Amaya. Then,
of course, there are so many other letters. I will just highlight one I
received months ago now from Pam Simpson. She is from Coatesville, PA--
Southeastern Pennsylvania just outside the city of Philadelphia. Now
you are talking about Rowan in Southeastern Pennsylvania and Amaya in
Southwestern Pennsylvania, two corners of the State--two children
facing challenges that most of us can't even imagine.
In this case, Pam Simpson wrote to me about her son Rowan and talked
about his life before a diagnosis of autism and before he was getting
the help he is getting now. Pam talked about all of the challenges she
and families like her face. She talked about the fact that he was
having all kinds of difficulties, but then they finally got the word
that Rowan would be covered by Medical Assistance. That is the
Pennsylvania version of Medicaid at the State level. She said she
applied in January of 2016. After Pam got the word that Rowan would be
enrolled, she said:
We were able to obtain wraparound services, which included
a behavioral specialist consultant--so-called BSC--and a
therapeutic staff support worker. The wraparound services
have been a godsend--
Referring to the services provided to her son Rowan. Then she goes on
later in the letter and says:
Without Medicaid, I am confident I could not work full time
to support our family. We would be bankrupt or my son would
go without the therapies he sincerely needs.
Here is how Pam concludes her letter:
Please think of my dear Rowan and his happy face, his big
blue eyes, and his lovely strawberry blonde hair. Please
think of me and my husband, working every day to support our
family, and please think of my 9-month-old daughter Luna.
I will stop there just to explain. She is talking about Rowan, who is
a couple of years older. The reference here is to his younger sister
Luna.
Please think of my 9-month-old daughter Luna who smiles and
laughs at her brother daily. She will have to care for Rowan
later in her life when we are gone. Overall, we are
desperately in need of Rowan's Medical Assistance and would
be devastated if we lost these benefits.
That is what Pam Simpson wrote to me months ago. After referring to
her story and Rowan's story over the last couple of months, I finally
had the chance to meet her and to meet Rowan and his dad and his sister
Luna. So I met this family--four people in a family. I met them on
Friday. It is one thing to read about it and to get a sense of what a
family is up against every day, and it is another thing to meet them.
Right now, the Simpson family has what they need for Rowan. That
doesn't mean they don't have challenges. It doesn't mean it will not be
difficult in the years ahead, but they have the benefit of Medicaid
right now--Medical Assistance, as we call it in Pennsylvania.
Rowan now, because he has autism, has the benefit of those behavioral
specialists and Medical Assistance. There was a person with them the
day I met them, to work with Rowan every day so the parents can work
and have the peace of mind to know they can go to work, and they can
raise their family with the benefit of the kind of healthcare every
child should have. Some might say: You know what. If the Republicans
get their way on this bill, maybe the Medicaid provisions will not
apply to Rowan. Maybe he will be protected or maybe in Allegheny
County, maybe Amaya will be protected. Maybe it will not reach that
far. Maybe when the Congressional Budget Office--I will read directly
from page 17 of the report by the Congressional Budget Office analyzing
the House bill when it says: Medicaid enrollment would be lower
throughout the coming decade, culminating in 14 million fewer Medicaid
enrollees by 2026, a reduction of 17 percent relative to the number
under current law. That is what the Congressional Budget Office says
about the impact of the House bill on Medicaid--14 million people lose
their Medicaid.
Some might say: Let's assume for purposes of this argument that those
two children we just spoke about might be protected from those cuts. We
don't know that, of course, and they can't guarantee that because what
they are doing when they go at these Medicaid provisions is taking away
the guarantee that has been there for 50 years and, over time,
eliminating the Medicaid expansion. That is what we expect to happen.
That is certainly what the House bill did.
Let's assume for the sake of argument that they could come in here
and make an ironclad guarantee that those two children, Rowan and
Amaya, won't be affected. You know what. That is not good enough. That
is not good enough because there are a lot of other children who will
be affected, children who might have a disability.
Sixty percent of children with disabilities are enrolled in Medicaid.
We know that. We know that millions of other children who come from
low-income families get the benefit of Medicaid. We know that a lot of
seniors depend upon Medicaid to get into a nursing home. But no family
who has a child with disabilities who benefits from Medicaid should
have to worry for 15 minutes about what would happen in this Chamber--
because a small group of Republican Senators are meeting in secret, and
they are supposed to produce a bill that we are all supposed to
consider in a short timeframe--no product of that secret process should
in any way give any parent who has a
[[Page S3594]]
child with a disability any concern at all that that benefit will be
taken away. That is not who we are as a country. We are America. We
take care of people who need those kinds of services, that kind of
benefit.
So if a child like Rowan, who is receiving the benefits of Medicaid
today because of his disability--if a child like that is receiving
those services today, we should guarantee that he will receive those
benefits for as long as he needs those benefits. Even if it goes the
length and breadth of his life, we should guarantee that, take it off
the table so that family doesn't have to worry.
That, I hope, would be the result of this process undertaken by a
small group of Republican Senators. I have been waiting to hear that,
waiting to hear whether they will guarantee that to that child, to give
that family some peace of mind with all the challenges they have, even
with Medicaid, even with the great support they get. It is not easy. It
is a very difficult life many families lead when they have a child with
a disability. But we should do everything we can to make sure that if a
child with a disability--just one category of people who benefit--any
child with a disability who gets the benefit of Medicaid should have
that protection for as long as they need it. And I will be waiting to
hear that from our colleagues when they finally emerge from this
secretive process with the bill. So I hope that is what they are
working on in their meetings because we know that it affects a lot of
children.
As I said before, Medicaid covers 60 percent of all children with
disabilities, ranging from autism, like Rowan, to traumatic brain
injuries. We know that children on Medicaid receive what many consider
the gold standard for children's healthcare--early and periodic
screening, diagnostic and treatment options, so-called EPSTD--so they
can get the screenings they need, so they can get preventive healthcare
when they need it.
All of these protections should be not just a goal, they should be
guaranteed for those children. I am hoping our friends who are working
on this right now will consider Rowan and Amaya and children like them.
We will come back to it later. We will have other stories to tell
about children and what they are up against. But on a night like
tonight, I am thinking of those children and worried about some of the
headlines we are seeing on some analysis.
I will wrap up with this: The Center for American Progress report
dated May of 2017 is titled ``Cuts to Medicaid Would Harm Young
Children With Disabilities.'' That is one report. Another report is
from the Center on Budget and Policy Priorities, May 18, 2017:
``Medicaid Cuts in House ACA Repeal Bill Will Limit Availability of
Home- and Community-Based Services.'' That is another headline. We
won't get into the details of those reports now.
We have a lot to work on here to make sure that nothing that happens
in this process will rip away healthcare from children with
disabilities.
I yield the floor.
The PRESIDING OFFICER (Mr. Perdue). The Senator from Oregon.
Mr. MERKELY. Mr. President, I commend my colleague from Pennsylvania,
who is putting forth a powerful message about our values, and that is
that every child in America should have access to healthcare, and no
one in this Chamber should vote in a process or for a bill that
eviscerates that coverage. In fact, our value is that no one in
America, including our adults, including our older Americans, including
our seniors, and including our children for sure--everyone should have
access to affordable healthcare and never have the stress of being
worried that if their loved one gets sick, they might not receive the
care they need. They should never have the stress of concern that their
family member might go bankrupt because they need medical care. It is
that value which we are here tonight fighting for, and it is that value
which the Republican bill will destroy, ripping healthcare away from
millions of Americans. So we come here tonight with a battle cry, and
that cry is: No hearing, no vote. No hearing, no vote.
We are a democratic republic. We are a legislative Chamber. Have
Members of this Chamber forgotten that we are a ``we the people'' form
of government where the people are in charge? The people are not in
charge if a secret 13 group of Senators is hiding in the basement
crafting a bill to rip healthcare away from millions of people. The
people are not in charge if they are afraid to show their bill to
everyday Americans. They are not in charge if they are planning to
destroy healthcare so those with preexisting conditions can't gain
access to care.
Never have we seen a group in the majority so against the fundamental
principles of our democratic Republic, so against the ``we the people''
vision of our Constitution, and that is why we are calling on them to
stop, rethink, remember, absorb the values embedded in our beautiful
``we the people'' Constitution. They want no public disclosure--fear of
how the public will respond. They want no committee hearings--fear of
how the people in America will respond. They want no committee
amendments because that will take time in which the people can see what
is going on and respond. And they want no substantial floor
consideration in order to shove this through so they can go and
celebrate the Fourth of July with their constituents, while having
eviscerated the Constitution of the United States in the process of
attending that Fourth of July gathering.
This has been called the vampire bill, the Republican vampire bill.
Why? Because the writers of it, the secret 13 writers, are afraid for
the bill to see the light of day. It is hiding in the darkness. And it
is called the vampire bill because its general intent is to suck the
life out of the healthcare system for struggling families, suck the
life out of the healthcare system for working families and for middle-
class families.
This is quite different from the consideration when we created the
system that we have now back in 2009. In that year, in the HELP
Committee--Health, Education, Labor, and Pensions Committee--there were
47 hearings, roundtables, and walkthroughs, a markup that went for more
than a month--the longest markup in that committee in the history of
the United States of America; a markup that considered over 300
amendments; a markup with, in fact, a group of Senators, bipartisan,
sitting around the table with the television cameras rolling while they
debated those amendments and voted on those amendments. And in that
committee, they accepted or approved by vote more than 100 minority
amendments.
Then there is the Finance Committee, which held 53 hearings and
roundtables. In fact, the minutes of the roundtable are available, and
if you want to print them out and read them, they go for 800 pages--
just the roundtable minutes. And then they had their own Finance
Committee markup, where they considered 135 amendments. Then the bill
came to the floor in December 2009, and there was 25 days of debate on
the floor.
Let's compare that to the plan of the majority leader and the secret
13. Well, how many hearings do they want? They want zero in the HELP
Committee. How many hearings do they want in the Finance Committee?
They want zero. How many Democratic amendments do they want to
consider--or Republican amendments--in the HELP or Finance Committee?
The answer is zero. How much floor time do they want to have? They want
to have just 1 day--just 1 day. They want to introduce it as an
amendment to the House TrumpCare bill and pass it on the same day. And
how many days do they want experts to be able to weigh in on a
healthcare system? Zero. But here is the most important zero of all:
How much time do they want for the American citizens to be able to see
this bill and respond to this bill? They want zero time. That is
completely against all the premises of our responsibility as
legislators. It is against all the fundamental visions of a body that
will deliberate and debate and take into account the opinions of the
people and the insights of the experts.
Well, we can turn the clock back not so long ago to the majority
leader, who said: ``Fast-tracking a major legislative overhaul such as
healthcare reform . . . without the benefit of a full and transparent
debate does a disservice to the American people.'' That was Majority
Leader Mitch McConnell speaking not so long ago. What happened to that
value? That was being said when we had 25 days of debate here
[[Page S3595]]
on the floor; when we had over 100 minority amendments--that is,
Republican amendments--accepted; when we had a lengthy debate in the
Finance Committee and a lengthy debate in the HELP Committee, but the
majority leader wanted more time. Here he is today leading the effort
to have zero input from the American public, zero input from healthcare
experts, zero committee deliberation, zero bipartisan discussion of the
pros and cons.
Well, we can turn to Paul Ryan. What did he think back in 2009? He
said: ``Congress is moving fast to rush through a health care overhaul
that lacks a key ingredient: The full participation of you, the
American people.''
He went on to write: ``Congress and the White House have focused
their public efforts on platitudes and press conferences, while the
substance and the details have remained behind closed doors.''
Well, it was kind of a rewriting of history even at that moment in
time when he said that when there was a record-setting debate in the
HELP Committee, the second longest debate in history in the Finance
Committee, television cameras running the whole time, 100 Republican
amendments adopted, more than 100 meetings and walkthroughs and
roundtables and committee meetings, and 25 days on the floor. But Paul
Ryan said that what it was lacking was full participation of you, the
American people.
Well, if it was lacking in 2009, what do we say about this when the
majority deliberately wants to exclude the American people, when the
American people are standing at the door, when they are standing at the
windows and they are leaning in and saying: What is in this bill? We
want to have a say because it is so important to our families.
And the Republicans are slamming the door, and they are shuttering
the windows and saying: We will not share one word with you because we
know you won't like what we are doing.
That is not the way democracy is supposed to work.
Erin from Portland wrote because she has been diagnosed with diabetes
and is terrified that if the Republican plan goes into effect, she
won't be able to afford coverage because of her preexisting condition.
Jeannette from Portland wrote. She is in her sixties and desperately
waiting to turn 65 and qualify for Medicare. She is on the Oregon
Health Plan and terrified that she will lose that plan before she
qualifies for Medicare. The list goes on and on and on.
This weekend, I was out conducting townhall meetings in 4 different
counties of my 36 counties. I go to every county every year. And these
four counties are counties that voted--I am sorry to say--
overwhelmingly against me when I ran for the U.S. Senate and
overwhelmingly against me when I ran for reelection. They are red
counties; they are Republican counties.
Folks came out to my townhalls this weekend, and they sent one
message to our Republican leadership in the Senate: We the American
people demand the chance to participate in this debate. It so
profoundly affects our quality of life.
So I carry their messages from Klamath County and from Lake County,
and I carry their messages from Grant County and Wheeler County to the
Republican majority: Listen to the American people. Listen to rural
America. Listen to the families who will be devastated by the plan you
are concocting with the secret 13. It is not right. It is not moral. In
fact, we need to work together to improve healthcare, not to devastate
it.
Thank you, Mr. President.
The PRESIDING OFFICER. The Senator from Minnesota.
Ms. KLOBUCHAR. Mr. President, I rise today to join my colleagues, to
speak out, and to ask for a normal process here and to ask for
hearings, to ask for debate, and to ask for amendments because the
healthcare repeal bill is a major step backward, throwing over 20
million people off of health insurance. It is strongly opposed by AARP.
We don't know what is being concocted here in the Senate, but clearly
something is going on, and we would like to have a say, and, most
importantly, the people of my State would like to have a say.
Look at Laura from North St. Paul, who wrote to me about her concerns
about that health bill. Laura is recently retired, but she will not be
eligible for Medicare until next year, and she has a daughter with
several chronic health conditions. Laura is worried that if the
proposal goes through this Chamber, she will end up paying far more for
her health insurance, and her daughter might lose her coverage
altogether. Like so many others, Laura asked that we work across the
aisle to make improvements to the bill that her family needs and that
so many families across the country need.
Take Mike from Grand Marais, which is in the far corner of Minnesota,
right at the tip of our State, not too far from Canada. Mike knows the
kind of healthcare they have across the border in Canada. He knows what
the prices are for the prescription drugs there, but here in America
that healthcare bill doesn't do anything to bring down the cost of
prescription drugs.
Mike has been self-employed his whole life and is now approaching
retirement. He told me that he is very worried that, just as he is
about to retire, he will not be able to afford health insurance because
the premiums that are under that bill for older Minnesotans like him
would skyrocket.
Take a woman from Andover, MN. She wrote to me to say that she is so
worried ``about the GOP's slam dunk attempt to check off a box on their
to do list'' with the healthcare proposal. She asked me to put a face
on the type of person that will be a part of that checklist on that to-
do list, and that would be her 28-year-old son. She says that Medicaid
coverage has been a lifesaver for her son because it helps him afford
the treatment he needs to strive for an independent, productive life.
The truth of the matter is that I have heard so many people like
these three, from all corners of my State, from the old to the young to
the middle-aged. I have heard from so many people from the rural parts
of my State about this bill. They are especially worried about the $834
billion in cuts to Medicaid. Medicaid covers more than 1.2 million
Minnesotans, including more than one-fifth of our rural population.
That is 20 percent of our rural population. This funding is vital for
our rural hospitals and the healthcare providers' ability in those
parts of our State to stay open and serve their patients.
Many people who work in rural hospitals and those who are served by
rural hospitals have come up to me to talk about their concerns. These
hospitals are not like big urban hospitals.
I see the Senator from Hawaii here. I thank him for organizing this
along with Senator Murray.
Our rural hospitals actually treat a lot of accidents, people out
snowmobiling or on ATVs. In fact one of them has a chart every summer
showing all the places where they had to remove fish hooks from
people's hands. They usually have over 100 of them by the end of the
summer. You wouldn't see that in an urban area--that is for sure--but
it just shows that different parts of our country, different parts of
our State have different issues they are dealing with.
Rural hospitals are particularly concerned about these cuts. These
drastic cuts would cause many of our rural hospitals to close, forcing
families to drive 60, 70, 80 miles or more when they need the
healthcare the most.
The other issue that this bill brings up to me, when looking at rural
areas, is the opioid epidemic that is hitting communities across the
country. In my State, deaths from prescription drug use now claim more
lives than homicides or car crashes. While there is more work to do to
combat this epidemic, I want to recognize that we have made meaningful
progress so far in a bipartisan way. We passed the framework bill, the
CARA bill. We passed the Cures Act last December, as well as money to
fund treatment. Unfortunately, just as we are starting to move forward
on this issue, the healthcare repeal bill passed by the House would put
us at the risk of moving backward. There is money in that bill for
opioid treatment, but guess what. Medicaid and children's health
insurance covers 3 out of every 10 people with an opioid addiction. But
according to the nonpartisan Congressional Budget Office, mental health
and substance abuse benefits could be cut under the House bill,
increasing out-of-pocket costs.
[[Page S3596]]
It is clear that this healthcare legislation has massive life-
changing implications for families all over this country. Yet we
haven't even seen a draft in the Senate. What we do know is that, just
last week, the President of the United States, who is known for not
really mincing words and known for using direct language, called the
House bill ``mean.''
He called it ``mean.'' He didn't need a poll or a focus group. He
didn't need to know every detail of the bill, but when you hear that 20
million people can lose health insurance, that is a pretty good word to
describe it--mean. What we don't want to have in the Senate is that we
bring forward the Senate mean, or mean 2. But guess what. We don't even
know what we have because we haven't seen it, because the legislation
is being drafted behind closed doors. Most of us agree that we must
make changes to the Affordable Care Act. I certainly think so. I would
love to pass my bills or include them in amendments to the Affordable
Care Act to bring down the cost of prescription drugs.
My bill would allow 41 million seniors to harness their negotiating
power to bring drug prices down. Right now they are banned to do that.
That is wrong.
I would love to see more competition come into the market in the form
of less expensive drugs from other countries, like Canada--a bill I
have with Senator Kaine or a bill to make it easier to get generics on
the market, like the bill Senator Grassley and I have to stop something
that is called ``pay for delay.'' I think the American people would be
surprised that the big pharmaceutical companies are paying their
generic competitors to keep their products off the market. These are
improvements to the bill.
We can make improvements to the exchanges. Just as we have done some
of that work in the State of Minnesota, we can do that nationally. We
can make improvements to small business rates. Those are things we can
do, but we cannot do it if we can't get through the door because the
door is closed. When the door is closed, it is not just closed to the
Democrats and Republicans in the Senate, but the door is closed to the
American people.
What it all comes down to is that we need to work in a bipartisan way
to make healthcare better and less expensive for the people in our
country. Last week, we all came together. I was at that Congressional
Baseball Game. It was an amazing moment, with 25,000 people in the
stands. All four leaders were out there looking like they actually
liked each other. There they were, and there our teams were--two teams,
a Republican team and a Democratic team. In the end it was a hard
fought game. One team won. The Democratic team won, but do you know
what they did with their trophy? They handed it to the Republican team,
and they said: Put it in Representative Scalise's office.
We want to take that spirit and go even further--instead of two
teams, one team for America. That is the way we make the changes to an
issue that has been long fought on both sides. I know Republicans
weren't happy with everything that happened during the debate on the
Affordable Care Act. They have made that clear. But now we have a
moment in time where we could come together and make some sensible
changes and make things better for the people of this country. Let's do
it.
I yield the floor.
The PRESIDING OFFICER. The Senator from Minnesota.
Mr. FRANKEN. Thank you, Mr. President.
I rise today to talk about the Republican effort happening in total
secrecy behind closed doors under the direction of Leader McConnell to
repeal the Affordable Care Act and gut Medicaid in order to give huge
tax breaks to the wealthiest Georgians, the wealthiest Americans.
Just about 5 months ago, I came before this body. I issued a simple
request to Republicans. I asked you to show me your plan to repeal and
replace the Affordable Care Act.
I asked you to show me the plan that was going to be ``terrific.''
As to the bill that President Trump promised during his campaign and
the one Republicans had 7 years to come up with, I asked you to explain
how you would meet the standards set by one of President Trump's top
advisers, Kelly Anne Conway, who said: ``We don't want anyone who
currently has insurance to not have insurance.''
I asked you all to show me the plan that retains coverage for the
nearly 20 million people who have gained it, continues to contain
healthcare costs, and ensures that nobody gets denied or has to pay
more because of their gender or because of preexisting conditions.
I never got that plan from you. Instead, what we received was the
American Health Care Act, or the AHCA, a heartless, terrible bill that
passed the House in early May, a bill that President Trump heralded in
the Rose Garden, after its passage, as ``great.''
The AHCA is a far cry from what President Trump and his allies
promised. If the AHCA becomes law, 23 million more people would be
uninsured. The bill ends protections for people with preexisting
conditions and drives up healthcare costs dramatically for older,
sicker folks. Worse still, the AHCA would end the Medicaid expansion
and slash Medicaid by $834 billion over 10 years. For what? To offer
massive tax breaks to the wealthiest Americans, for the wealthiest
Georgians in the Presiding Officer's State. The average tax savings for
the 400 richest families under this plan is $7 million apiece each
year--$7 million each for every year, because they need it.
No wonder people are outraged. Just 8 percent of Americans think the
Senate should pass this bill into law unchanged. Well, 8 percent has to
be a new low.
Americans do not want TrumpCare. Three in four Americans want
President Trump and his administration to do what he can to make the
ACA work rather than undermining it.
Even President Trump reportedly now considers the House bill to be
``mean.'' It went from ``great'' to ``mean.'' In the Rose Garden, it
was great. Now, a few weeks later, that same great bill is mean.
Instead of listening to the American people, Republicans are pursuing
a strategy that former Acting Administrator of CMS Andy Slavitt has
described as sabotage, secrecy, and speed.
Up first, sabotage.
In a few years, Republicans have choked off the Risk Corridors
Program, which was designed to help stabilize premiums in the first
years of the new exchanges. The Trump administration has gone even
further. It has stopped enforcing the individual mandate, has
undermined outreach efforts to help people sign up for health
insurance, and has cut in half the amount of time that people have to
sign up for health insurance coverage.
Perhaps the most troubling of all is that Republicans have refused to
commit to funding cost-sharing reduction payments. These payments help
low-income families cover their out-of-pocket costs. Since insurers are
not sure if they can count on the administration to continue to provide
these payments, some are pulling out of the individual market or are
dramatically increasing their premiums to account for this instability,
this uncertainty.
There is much more we can do to shore up the individual market, but
my colleague Senator Stabenow had it right when she said to Secretary
Price, of the Presiding Officer's State, regarding the administration's
sabotage efforts: ``It's like pulling the rug out from under somebody
and going, `Oh, my gosh. They fell down.' ''
That was from Debbie Stabenow, of Michigan.
The next tenet of the Republican approach is secrecy.
A group of 13 men has been meeting in secret to draft the Senate
version of the AHCA. What little we do know is that Senator Cornyn
estimates there will be about an 80-percent overlap between the Senate
and House bills. Prior to now, our understanding was that the Senate
Republicans would completely rewrite the bill, with Senator Burr even
saying the House bill was ``dead on arrival.'' It sounds like that plan
has been jettisoned, but we cannot be sure because the Senate has had
precisely zero hearings, zero days of public floor debate, and we have
yet to see or hear about the revised draft of the AHCA, despite the
forthcoming vote.
I urge my Republican colleagues to recall that during the long debate
over the Affordable Care Act, the Senate held nearly 100 bipartisan
hearings, roundtables, and walkthroughs, and had 25 consecutive days of
public floor debate. Let me repeat that--nearly 100
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bipartisan hearings, roundtables, and walkthroughs in the Senate alone,
with 25 consecutive days of public floor debate on a bill that affects
one-sixth of our economy. In the Senate HELP Committee, Senators
considered nearly 300 amendments during a 13-day markup--one of the
longest in congressional history--and ultimately accepted more than 160
Republican amendments in the process.
In 2009, then-House Budget Committee Ranking Member Paul Ryan argued:
Before Congress changes healthcare as the American people
know it, we must know the likely consequences of the House
Democrat legislation, including the number of people who
would lose access to their current insurance.
The irony is palpable. Feel the palpable irony. Do you feel it? Does
everybody feel it?
That brings me to the final component of the Republican approach, and
that is speed.
Leader McConnell would prefer to have a vote on the Senate plan
before the July 4 recess or shortly thereafter. That timing only leaves
us with a few days to go. There will just not be enough time to truly
understand how this bill would affect the healthcare system, which,
again, is one-sixth of our economy and affects all of the millions of
Americans who rely on it.
Republicans plan to schedule the vote in such a way as to keep the
American people in the dark about this bill for as long as possible.
The American people deserve a chance to weigh in on a bill that would
affect their lives and those of their friends and families in my State
of Minnesota and the Presiding Officer's State of Georgia.
My office has received over 15,000 letters from very worried
Minnesotans these past few months, and I have gone to visit rural
healthcare facilities that would be among the hardest hit by the AHCA.
My constituents--the people of Minnesota--are frankly scared about what
will happen to them or their families if they lose their health
insurance, and I am too.
As I did in January, I would like to encourage my Republican
colleagues to join me on a trip to Minnesota to meet Leanna. Leanna's
3-year-old son Henry has been diagnosed with acute lymphoblastic
leukemia. His treatment will last until at least April of 2018. He
needs around-the-clock care to manage his nausea, vomiting, pain, and
sleepless nights. Henry's immune system is so compromised that he is
not supposed to go to daycare so Leanna left her job to care for him.
Henry and Leanna are supported by Leanna's spouse, but they cannot pay
for his treatment on one salary.
Leanna says:
It is because of the ACA that Henry gets proper healthcare.
Henry can get therapy and the things he needs to maintain his
health and work towards beating cancer. Henry is still with
us because of the ACA.
He is 3.
Let me say that again: ``Henry is still with us because of the ACA.''
I will do everything I can to fight the Republican effort to repeal
the Affordable Care Act, strip away consumer protections, and gut
Medicaid.
To all of my constituents who care about this, I need you to keep
fighting. Now is the time to make your voices heard.
I thank the Presiding Officer for his attention.
I yield the floor.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. WHITEHOUSE. Mr. President, I am pleased to follow the Senator
from Minnesota, as because of him I had the chance to be on the HELP
Committee during all of those hearings--all of those dozens and dozens
of Republican amendments that took place during the vibrant, robust,
bipartisan process in the HELP Committee. Senator Franken was still in
litigation over his election so his seat on the HELP Committee was
vacant, and Harry Reid asked if I would take that seat. My senior
Senator Jack Reed and I, both of Rhode Island, were there in the room
day after day, week after week, while this exhaustive, public,
bipartisan process went forward.
I can even remember working with Senator Isakson, of Georgia, and
supporting his amendment that would allow a doctor to be paid for
having a conversation with a very ill patient about what his desires
were if his condition did not get better. What type of end-of-life care
did he want? Did he want every possible intervention or did he want
dignified time at home with his family? What were his desires? That is
a conversation that is important for doctors to have with those
patients.
In the environment of the time, that became the death panel phony
story. So I was there. I saw it happen. Thanks to Senator Franken's
delay in getting here, Jack Reed and I were in the room.
Why does this matter? This matters because, like the story of Leanna
and Henry, there are people on the other side of what is--apparently,
for our Republican colleagues--a purely political piece of
parliamentary chicanery.
I have a constituent, a woman named Pamela, who lives in Jamestown,
RI. She works with people and nonprofit organizations that advocate for
people who have very rare diseases so, in her work, she has seen the
before and after of the Affordable Care Act.
``Before the Affordable Care Act,'' she wrote to me, ``I saw many
patients and families distraught by medical bankruptcy.''
Then it came even closer to home for Pamela when she was diagnosed
with stage IV breast cancer. If there were an annual or a lifetime
limit on health benefits, she would be in deep trouble. If the
protection for people with preexisting conditions were undone, that
would imperil her ability to get insurance in the future.
She wrote to me:
As a patient myself, with a chronic, costly medical
condition, I am very worried that [these] protections will be
taken away, making my life-sustaining care unaffordable.
Pamela deserves to be heard, but nobody can speak up for her with a
bill that nobody can see.
From Cumberland, Marilyn wrote to me. Marilyn is a family physician.
She knows the healthcare system. She also has severe asthma. She has
had asthma since she was a little child, and she manages her severe
asthma with very expensive medication. Her husband is retired, and
Marilyn purchased her health insurance through HealthSource RI--our
ObamaCare health insurance marketplace--which, by the way, is working
very well. There is no need to undo what is going on in Rhode Island.
It gives her peace of mind, and she wrote to me to say she was
terrified by the possibility that the preexisting condition clause will
be allowed back in.
She wrote:
I am not a specialist but a family medicine physician,
doing the best I can to pay my student loans and daily
expenses. I could not afford the lifesaving treatment I
require to function. . . . I do not know how I would survive
financially if the current legislation the House has approved
is allowed to become law.
Gina wrote to me from Lincoln, RI. Gina's daughter, Sofia, is 6.
Sofia has cerebral palsy. We think we have problems here. I tell you,
whatever the political problems we have over the Affordable Care Act,
have a 6-year-old with cerebral palsy, and then come back and tell me
you have a problem not liking ObamaCare.
Sofia needs round-the-clock care and she gets it because of Medicaid.
Gina wrote to me: ``From her home nursing care to her wheelchair, we
could not live without [Medicaid].''
Before Sofia came along, Gina and her husband never imagined they
would need Medicaid; it never crossed their minds. But now, the welfare
of their little daughter is entirely dependent on Medicaid. Depending
on what we do here, Gina wrote:
Will there even be a Medicaid then? This administration is
stripping benefits from the most vulnerable in our society.
How will they survive?
The last story I will share is from Tony and his family, who live in
North Kingstown, RI. Tony has a son whose name is Michael. Michael,
right after he was born, was diagnosed with something called
mitochondrial disorder. It is a severely, catastrophically debilitating
illness. It left Michael severely disabled. Michael is 10 years old
now, but developmentally he is more like a 3-month-old. He can't walk,
he can't talk, he can't feed himself, but he is happy, and he is sweet,
and he is a source of joy for his parents and his four siblings.
Through Medicaid, Michael can receive up to 30 hours per week of care
from a certified nursing assistant. It is
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this program--it is Medicaid--supporting the certified nursing
assistant those 30 hours per week that lets Michael live at home with
his parents and those four siblings. Otherwise, he would have to be
institutionalized. Somebody explain to me why a political victory
shoved through this body after secret proceedings is worth explaining
to Michael's parents that he is at risk of losing that coverage.
When President Trump said that the House bill was mean, he was not
kidding around. It is mean, mean, mean--dirty, rotten mean. And if you
think the one on the Senate side is going to be any better, there is
one little phrase I would like to bring to your attention: ``We're not
stupid.''
``We're not stupid'' is what a Republican staffer said when he was
asked, Why aren't you guys having a public process? Why are you trying
to jam this through in secret? His answer: ``We're not stupid.''
Well, what can you logically deduce from that? What kind of bill
would be stupid to show the American public? If this was a bill that
was going to be greeted with great applause and joy and relief and
satisfaction by the American public, would you hide it? No. If it were
terrible, if it would threaten people all across this country, then you
wouldn't want them to see it. That would be stupid.
So that is what they are up to. They know perfectly well that this
bill is not good for America. That is why showing it to the American
people would be, by their own words, stupid.
Let me switch to my geek point before I go, because this is something
I talk about a lot, and it bothers the heck out of me. This is a graph
that shows healthcare in most of the countries that compete with us--
the OECD nations.
This chart shows life expectancy in years. At the bottom is 72, at
the top is 86, so where you fall in this shows where your life
expectancy is in the different countries, and life expectancy is a
pretty good measure of how good the healthcare system is.
Here is the cost of healthcare per capita, averaged across the
population. And as you will notice, most everybody is right up in
here--Japan, Switzerland, Netherlands, United Kingdom. Most of our
competitors, including France and Germany--they are up in here. Where
are we? Out here. The most expensive other country in the world is
Switzerland, which doesn't break $6,000 per person; we are over $8,000.
The average in here, where Japan comes in, above where the United
Kingdom comes in, is $4,000 per person; we are above $8,000. We are 100
percent more expensive than the average and more than 50 percent more
expensive than the least efficient other country in the world.
So there is progress to be made at bringing costs down, if we would
pay attention to this real problem instead of the imaginary problem of
Americans having too much healthcare.
And over here--look at the life expectancy in years. Look where we
come in. We match the Czech Republic. So there is progress to be made
on cost and on outcomes in this country. And, believe it or not, we are
actually starting to make a little progress. Let me take my colleagues
through this graph, and then I will leave you be.
This top line was drawn by the Congressional Budget Office back in
2010. They project forward into the future where they think healthcare
costs are going to go. These are all Federal healthcare costs; the
whole Federal healthcare costs, all of them piled up--Medicare,
Medicaid, veterans--all of it. So here is what they projected it would
be, this top line, in 2010. Then, they got to 2016, and they did
another projection because they realized that as of 2014, things were
coming in below their expectations. After the Affordable Care Act,
things started to change. So they did another projection in 2016, and
they projected this line right here.
Those of us who serve on the Budget Committee know that we think in
10-year increments. So here is a 10-year increment from 2017 to 2027.
And if you look just at the difference between what CBO predicted in
2010, before the Affordable Care Act, and what they predicted in 2016,
after the Affordable Care Act: $3.3 trillion in savings--$3.3 trillion
in savings. Think of what a difference that makes for our country if
you can save $3.3 trillion in our healthcare costs.
Healthcare costs are what is driving most of our debt and our
deficit, so $3.3 trillion in savings? I tell you what, I want to see
this bill because I want to know what CBO thinks about what happens to
that $3.3 trillion in savings. If the cost of this Republican
parliamentary chicanery is going to be losing $3.3 trillion in savings,
the American people ought to know about that.
So I call on my Republican colleagues to have a process. I don't know
if the Presiding Officer has seen the bill yet. It is so close hold, I
don't think all of the Republicans have even seen it. But for gosh
sake, when you have these stories from Rhode Island and from all the
other States around the country, when you have real fellow Americans
counting on the healthcare that the Affordable Care Act made possible,
the idea that you throw that out to score political points and to give
super rich people a tax break is disgraceful. It is a disgrace.
I yield the floor.
The PRESIDING OFFICER. The Senator from Hawaii.
Mr. SCHATZ. Mr. President, I want to give a status report on this
bill. Right now, we think it is with the 13 men who are working on it
in secret; they will show it to Republican lobbyists, and then they
will send it over to the CBO for a score, and eventually the American
public and the Senate will be able to see the bill.
We will have a process called vote-arama, which is mostly nonsense,
and there will be lots of opportunities to offer amendments, but let's
be clear about what happens at the end of vote-arama. The leader will
offer an amendment in the nature of a substitute. So what does that
mean? That means all of the amendments that were adopted along the way
get taken out, with one 51-vote margin, and all of that vote-arama was
for show because Mitch McConnell will put his bill on the floor that
was negotiated in secret with those 13 people.
If there was any question that our democracy is being rolled over by
Senate Republicans, I want you to think about these 13 men. They are
drafting a bill without any input from women, from Democrats, from
experts, and by working in secret they are cutting out about 250
million people who are from the 40 States who aren't represented among
those 13 men. You can bet that those 40 States have unique healthcare
needs and unique healthcare laws. And without the right language, the
bill could throw healthcare in each of those States or any of those
States into total chaos.
They have also cut out Senators on the Health, Education, Labor, and
Pensions Committee and the Finance Committee, even though these
committees are actually constructed for the purpose of working on
legislation like this. They know how to get things done like this.
There are members of the HELP Committee and the Finance Committee who
are among the experts on this issue, yet they don't get a chance to
even see the bill. These Senators have jurisdiction over this
legislation, but they are being left out. This is just not the way it
is supposed to work.
We need transparency. We need bipartisanship. But now the Republicans
will try to tell us that the hearings are bypassed all the time. That
is not true. In fact, this body will hold a hearing on almost anything.
In 2017 alone, the Senate has had hearings on hot tub safety, self-
driving cars, a treaty for outer space, multimodal shipping, the
maritime administration, and dozens of other issues. Look, those are
actually not to be trivialized. It is important for the Senate to have
hearings. It is important for subcommittees to do their work. But
nobody can tell me that hot tub safety, self-driving cars, a treaty for
outer space, multimodal shipping, and the maritime administration are
more important than one-sixth of the American economy. It is a joke.
We are talking about one-sixth of the American economy, about
millions of jobs, and about people with life-threatening diseases and
life-changing medical bills, so we know how important hearings are to
do legislation. When the Senate took up the ACA, there were almost 100
hearings. Think about that: 100 hearings versus 0. There were
roundtables and walk-throughs held by the two committees. We considered
hundreds of amendments and accepted
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more than 150 amendments from Republicans. But, for this bill, no
markup, no transparency, no bipartisanship--just 13 men meeting in
secret outside of the regular process.
The only thing that has changed is now the market is under siege, but
the market is under siege because of the Republican administration.
They are purposefully creating uncertainty. That is not a rhetorical
flourish; they are saying they are doing that. President Trump actually
said he wanted to create uncertainty in the healthcare market in order
to create leverage with Democrats.
Think about how unusual that is. Think about how offensive that is.
It is perfectly appropriate for one party to try to generate leverage
in a negotiation against the other. That is part of politics, either in
an election context or in the public policy context. But the way that
this President and Tom Price are trying to generate leverage is by
raising healthcare premiums in order to force Democrats to buckle. That
is unheard of. It really is unheard of. And it hurts everybody across
the country to create this uncertainty.
It is bad enough that the Republicans are trying to take healthcare
away from 23 million people--from nursing home patients and their
families, from women who are pregnant or fighting breast cancer, from
sons and daughters and moms and dads who struggle with opioids. But to
add insult to injury, they are going to jam it down your throat. You
don't get to read what it is about before it passes or hear from
doctors or nurses or experts about how it will affect you.
So why are they working on this bill in secret? The answer is very
simple. The bill stinks. They are ashamed of it. The bill itself is an
embarrassment. The process is an embarrassment. They have said so
themselves. No matter how you look at this, this bill is a disaster for
people and their families. It will be a disaster for anyone who relies
on Medicaid, which will be cut by at least $800 billion, and Medicaid
is a safety net for people who need care but can't afford it.
Look at nursing home care. Medicaid covers three out of every four
long-stay nursing home residents. My wife's grandmother was in a
nursing home and just passed away, had great care, and wouldn't have
been able to get the care she needed were it not for Medicaid. This is
not an uncommon story--millions of Americans across the country of all
income levels. People think of Medicaid as for people who are not
financially in a position to get care in any given moment. That is
true. It does take care of the poor. But it also takes care of nursing
home care for people who worked all their lives and just don't have
enough. It is $9,000 a month in the State of Hawaii for nursing home
care. It is more than that for hospice care. We all know that nobody
escapes end-of-life care. Rich or poor, left or right, red, blue,
purple, nobody escapes this part of your life, and everybody needs
help. There might be a few people who save up enough cash money to be
able to shell out $10,000 a month for that kind of care, but for the
rest of us, Medicaid is that lifeline.
There are actually some Republicans who don't want to cut Medicaid.
They have seen how the program improves people's lives. Arkansas and
Kentucky, for example, expanded Medicaid. These States have seen big
jumps in the number of the people who now have their own doctor or have
gotten a checkup in the past year, people who are now more likely to
say they are in excellent health. But under TrumpCare, we will be back
to the bad old days.
This bill is also a disaster for older people, who will be hit with
what the AARP is calling an age tax. This will get a little wonky--not
as wonky as that referred to by my colleague who spoke about 5 minutes
ago but a little wonky. Right now, companies are not allowed to charge
any more than three times as much for an older person as a younger
person. Three times is the cap. But TrumpCare will increase that rate
to five times. So what happens is every year, as you get older, your
insurance costs will go up and up and up. That is why they call it an
age tax. In other words, many seniors will see premium increases that
can cost them thousands of dollars more each year at a time when people
are already struggling to find money to pay for healthcare.
This is also a disaster for patients who don't want to lose their
healthcare provider. Right now, an estimated one in five women goes to
Planned Parenthood clinics. I understand we have different views about
reproductive choice. I understand that. But we also understand--when we
are talking on the level about Planned Parenthood and when we are
talking about Federal funding for Planned Parenthood, everybody who
pays any bit of attention to this understands what Planned Parenthood
does for women across the country--again, conservative women,
progressive women; Planned Parenthood doesn't care. Planned Parenthood
is not using Federal funding for abortion. We all know that by now. It
is cancer screenings, and it is quality healthcare and birth control.
People talk about giving more choices for healthcare and saving
taxpayers' money, but the CBO estimates that defunding Planned
Parenthood will take away options for nearly 400,000 women across the
country and will cost taxpayers more than $130 million.
It is also a disaster for those struggling with opioid addiction.
This bill will take away treatment for mental health and addiction,
leaving hundreds of thousands of people fighting opioid addiction
without adequate health insurance. We saw the statistics that opioid
addiction, I believe, is killing more people annually than HIV/AIDS
killed at its apex. I believe it has either surpassed or is comparable,
in terms of cause of death, with car accidents. This is one of the
leading killers in the country, and Medicaid is the program that funds
opioid addiction for most of the people who get help.
This bill is also a disaster for patients with preexisting conditions
because it means we will be going back to the dark days when insurance
companies could charge you more for having a preexisting condition.
I have heard from people back home in Hawaii who are terrified of
what this could mean for their health. One woman wrote that she is in
the middle of a fight for her life against breast cancer, and she is
scared that under TrumpCare, she will lose her insurance, that she will
have to stop her treatments and could lose her life. A husband wrote to
me that his wife has stage IV breast cancer. She has had every possible
treatment and surgery imaginable to extend her life, but without the
guarantee of affordable coverage for all, her fight will quickly come
to an end. She is 29.
Even people without serious medical conditions will be affected by
this preexisting condition's nonsense. We know that because before the
Affordable Care Act became law, insurance companies were able to
discriminate based on what they determined to be a preexisting
condition.
One woman in Hawaii told me that in the days before the Affordable
Care Act, she was rejected by insurance companies because she had back
pain at one point in her life. The pain never came back, and she never
needed treatment again. She was young and healthy, but the insurance
company wouldn't give her insurance.
We cannot accept the end of nationwide protections for people with
preexisting conditions. We cannot accept high premiums or so-called
high-risk pools that have historically failed in giving people the
coverage they need and deserve. We don't have to do it this way.
We don't have the majority, and this is being done under a process
called reconciliation, which means that you don't need a filibuster-
proof majority; you just need 51 votes. So if you are proud of your
bill--we have Senator Hatch, chairman of the Finance Committee and one
of the most respected Republicans in the country, actually. We have
Senator Alexander, chairman of the Health, Education, Labor, and
Pensions Committee. Both have a long history of being able to do
deals--Orrin Hatch with Teddy Kennedy and my predecessor, Dan Inouye;
Lamar Alexander with just about everybody--Chuck Schumer, Patty Murray.
These are conservative Members of the Senate. There is no doubt about
their Republican credentials. But they are also people who are capable
of crafting legislation in the right way. I have no doubt they like
their gavels. I have no doubt they like chairing hearings. I have no
doubt they have the personal, intellectual, emotional, and political
[[Page S3600]]
stamina to go through a process which may take more than a couple of
days.
I will tell you, this is the world's greatest deliberative body--it
is--and these are a bunch of impressive people I serve with in the
Senate. But without a hearing, you get a garbage product. You get a
bill that just stinks, that staffers say they are keeping secret
because ``we're not stupid.'' They are so embarrassed at this product
that they are keeping it secret, because they know the moment this
thing gets posted, everybody from everybody's home State--and not just
Democratic States and not just purple States, but every home State is
going to say: My community health center is going to get shut down. My
opioid treatment center is going to get shut down. My hospital may no
longer exist.
They know this bill stinks.
There is a simple solution. All we need is three Republicans to say:
Let the Senate be the Senate. The House did whatever the House was
going to do.
There was a weird White House Rose Garden signing ceremony without a
bill even being enacted. It was the most bizarre thing I have ever
seen, where everybody was congratulating each other for inflicting pain
on the American people.
But the Senate has to be the Senate here, and what that means is that
we have to be that cooling saucer. We have to actually slow down and
have a deliberative process. All we need is three Members of the Senate
on the Republican side to say a very simple thing. They can be as
critical of ObamaCare as they want, they can be as partisan against us
as they want, but all they have to say is this: I am not voting for a
bill that doesn't get a hearing. I am not voting for a bill that
doesn't get a hearing. Let this thing see the light of day.
I yield the floor.
The PRESIDING OFFICER (Mr. Young). The Senator from Connecticut.
Mr. MURPHY. Mr. President, I thank my friend from Hawaii for
convening us here tonight.
This isn't theoretical. This isn't about numbers. This is about real
people. We know them. They exist throughout our States.
I have told this story a few times before on the floor of the Senate.
When I think about the progress that has been made over the course of
the last 6 years, I think about Betty Burger. Betty is a woman who
lives in Meriden, CT. Betty and her husband did everything we asked
them to do. They were morally upstanding citizens, contributed to their
community, had full employment, raised good kids.
Her husband switched jobs. He switched jobs, and he had a 1-week,
maybe a 2-week period of time in between those two jobs. As luck--or
lack of it--would have it, during that brief intermission between
employment, their son was diagnosed with cancer. The cancer then became
a preexisting condition, which meant her husband's new employer would
not cover the son as part of a family plan. The cancer progressed and
progressed and progressed, and this family, the Burgers, had no means
to keep up with the payments.
Their story, unfortunately, is not foreign to folks who have heard
from constituents who have gone bankrupt because of healthcare costs.
The Burgers lost everything. The Burgers first went through their
savings, then they went into their son's college account, then they
sold their car, then they sold their house. They lost everything they
had trying to make sure they had healthcare for their son simply
because he got diagnosed with cancer during the one tiny interim
between their family's insurance coverage. That preexisting condition
doomed that family. There but for the grace of God--that could be us.
That could happen to any one of us.
Yet, today, medical bankruptcy is, frankly, a thing of the past. Why?
Well, it is not because healthcare costs any less; it is because we
said we are not going to allow insurance companies to deny coverage to
someone because they have a cancer diagnosis. In fact, we are not going
to allow insurance companies to charge you more just because you are
sick. Guess what. People have been able to keep their college savings
account. They have been able to keep their car. They have been able to
keep their house even if they get sick. That is what this bill has
meant. Twenty million more people are insured, yes, but the number of
personal bankruptcies in this country has plummeted by 50 percent,
almost entirely because there aren't Burgers any longer. There aren't
people who had to live through what the Burger family had to live
through.
That is what this is about. This is about real people who are going
to go through miserable, terrible experiences because of the bill
Senate Republicans are just days away from putting onto the floor.
I know my colleagues have covered this exhaustively, but I just want
to show visually what CBO says the House bill does.
I know it is in vogue for the President and Republicans to say that
ObamaCare is in a death spiral, but that is not what CBO says. CBO says
that if you keep the Affordable Healthcare Act and actually implement
it rather than undermine it, rather than sabotage it, as the President
of the United States is today, the number of people who don't have
health insurance will remain fairly stable from 2017 to 2026. It is
about 28 million people. But if you enact the American Health Care Act,
the bill that passed through the House, that number goes almost
immediately from about 26 million up to 40 million. Right about 14
million people lose insurance right off the bat. Like within a
heartbeat of passing this bill, about 14 million people will lose
insurance, and then, over time, it grows to 51 million people. That is
not the affordable healthcare act in a death spiral. That is market
stability. This is a death spiral. The death spiral starts upon passage
of the act being secretly negotiated today.
I get it that 23 million is kind of a hard number to get your head
wrapped around. What does 23 million people really mean? These numbers
are so huge. So here is what 23 million people is. It is the entire
population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana,
Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, South
Dakota, and let's just throw in West Virginia. That is what 23 million
people is. That is a humanitarian catastrophe.
Remember, 23 million people is what you get to at the end of 10
years, but 14 million people lose it right off the bat. There is no way
for our healthcare system to provide coverage to 14 million people who
had insurance one day and then don't have it the next. By the way, they
tend to be the sickest people because that is who is going to lose
healthcare first.
Why are we doing this? Why would you choose to inflict this kind of
pain on people? Why would you ask to run for Congress in order to put
this kind of hurt on the American public?
Here is the answer. I wish this weren't the answer. I wish there were
a different answer, but here is the answer. Twenty-three million people
lose health insurance, and the cost of that is about $800 billion of
money out of the healthcare system. It is not coincidence that that
then gets transferred into 650 or so odd-billion dollars in tax breaks
for the pharmaceutical companies, the insurance companies, and for
really, really rich people. It is not just by accident that it worked
out that the amount of money you took from poor people and from middle-
class people and from sick people is the exact amount of money you are
transferring to the pharmaceutical industry, the insurance industry,
and rich people.
Here is another way of looking at it. Here is where the tax cuts go:
The lowest quintile, the second quintile, the middle quintile, even the
fourth quintile don't get a lot of money out of this tax break. It is
the top quintile, the top 20 percent of income earners who get an
average tax cut of $2,700.
Here is the big benefit: The top 1 percent of income earners--a
$37,000 tax cut out of this bill. The top 1 percent of income earners
get a $37,000 tax cut from this bill. Let me say that again: 23 million
people lose healthcare so that the top 1 percent of income earners get
a $37,000 tax cut. Who runs for Congress to do that? What constituency
is asking for the U.S. Congress to pass a bill that takes health
insurance from all sorts of working Americans, people who are playing
by the rules--people like the Burgers--in order to pass a tax cut for
the super wealthy?
I don't know what is happening behind those closed doors. I don't
know
[[Page S3601]]
exactly what they are talking about, but I am going to guarantee you
that it is not fundamentally different than what the House bill did,
which is what I am describing here. There are still massive numbers of
people losing healthcare, rich people getting a tax cut, and lots of
folks getting hurt. Why? Just because Republicans made a political
promise to do this.
I know I have other colleagues who want to talk. Let me turn for a
moment to this process because the process does matter. The majority is
breaking the Senate. They are breaking the Senate. Don't think this
will not be how this works if you are in the minority. The fact is, we
acknowledge that there is a lot that is still very wrong with the
American healthcare system. Our constituents command us to try to make
those things better. We would love nothing more than to sit down with
the Republicans and try to figure out how we can come together on a
path forward to make this healthcare system better. I know you don't
believe us, but you didn't even try.
I am not sure we believed you at the beginning of 2009 when you said:
We want to help people get insurance. We watched Republicans have
control of the Presidency and the House and the time Senate for a long
time without a lot of progress being made, but Democrats tried.
Democrats spent a whole year sitting down with the Republicans,
trying to figure out if there was common ground--holding committee
processes, exhaustive hearings. There were 30 days of Senate debate on
the floor. I get it; in the end Republicans didn't support that
package. I get that Republicans can lay blame at the feet of Democrats
for not crafting something that could win Republican support. I
understand how that argument works.
The fact is that when Democrats were in the majority, they tried.
They opened up the committee process. They let everyone in the public
see the debate we were having. Why? Because it is a big deal.
We are talking about one-fifth to one-sixth of the American economy.
If you are talking about reordering that biggest segment of the U.S.
economy, if you are talking about millions of people benefiting or
losing, that shouldn't happen behind closed doors.
My constituents, even though they are represented by Democrats, have
no fewer rights than the citizens of Iowa or the citizens of Texas who
are represented by Republicans. Why are my constituents not allowed to
see the details of what is about to happen to their lives? Why are only
a select group of Americans able to have a voice inside that room? Why
are the people of Connecticut going to get 3 minutes to look at this
bill once it hits the Senate floor? My constituents are Americans, just
as the constituents in Republican States are Americans. They deserve to
know what is about to happen to them.
You are breaking the Senate. It will not get put back together that
easily. These are tough questions. They are partisan questions, but it
doesn't mean there is not an obligation to try to find common ground.
If you can't find common ground, don't bury the proceedings behind
closed doors where nobody can see it.
People hate this bill. They hate this bill. They hate it in part
because they don't trust the process. When they see this balance--tax
breaks for pharma, insurance, and rich people--and then losing
coverage, they want to know why they lose and why super rich people
win, but they can't get answers because it is all happening behind
closed doors.
It is not too late. I will just end there. Senator Schatz said it
right: It is not too late. My Republican colleagues can reject this and
say: Let's start over. Let's sit down and see if there are some
Democrats who want to work on stabilizing these exchanges, seeing if
there is some middle ground, being able to build a bipartisan consensus
when it comes to the future of the healthcare system.
It is not too late. I think you are going hear that consistently from
my colleagues this evening.
I yield the floor.
Mr. BOOKER. Will the Senator yield for a question?
Mr. MURPHY. I have yielded the floor, but I will happily engage in a
colloquy.
Mr. BOOKER. Mr. President, can I ask the Senator from Connecticut a
question?
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BOOKER. Thank you very much.
The Senator's charts plainly showed who benefits from the Republican
bill that we saw in the House. The CBO, as he pointed out, plainly
demonstrates that 23 million Americans will lose healthcare. I have
heard him talk about this on other issues--how we as Americans are far
more connected than we realize and that while one family might suffer
from lack of health insurance--like the folks he talked about in the
beginning of his remarks--the reality is that when that child doesn't
get the healthcare they deserve, when they don't achieve in life the
great potential they might have, others suffer as well. You see this as
you travel to European countries. They have vastly more people insured,
vastly more investments in childhood education and childhood
healthcare.
I am wondering if the Senator can extrapolate for me for a moment
that this isn't just about individual families who are vulnerable. It
is really all Americans, who suffer when other Americans are not
getting the benefit of healthcare in this country.
Mr. MURPHY. I think we all got a gut punch earlier today. We received
news that the young man who just returned from North Korea, after being
abused and tortured there, had passed. If you read the statement from
his family, it was hard to read. You couldn't help but read that
without feeling your heart drop into your stomach. Why? Because this
was a young man with such promise ahead of him, who had that future
robbed from him.
I didn't know him. My colleague didn't know him. The people in my
State who were similarly affected didn't know him, yet they felt
something.
I think the reason this bill is so wildly unpopular is that people
are going to die. The fact is, if people don't get coverage for
addiction, if folks who are mentally ill don't get to see a doctor,
they aren't going to survive. Even those who have enough money to be
able to pay for the premium increases in this bill--they know there is
something a little evil in wanting to do this to people.
As my colleague remarked, even if you are not amongst the 23 million
people who lose insurance, the CBO also says your rates are going up
because when those people don't get health insurance, they show up
somewhere else in the system. They show up at the emergency rooms. They
get much more expensive care. That cost gets passed on to the rest of
us.
Even if you are lucky enough not to be amongst the 23 million, you
are going to be personally, financially affected by this. The CBO says
that everyone's rates will go up by 15 to 20 percent. Even if it is not
the money you care about, we are all connected, and nobody should want
this to happen to people. We are all weaker if we pass a piece of
legislation that ends up hurting people in such a real, meaningful, and
devastating way.
Mr. BOOKER. If I can ask the Senator from Connecticut one more
question--that interrelatedness is a part of a larger system. We all
benefit from these systems. My colleague mentioned hospitals, and
whether it is my family who gets injured and is rushed to a hospital or
a wealthy family or a poor family, those hospitals are a critical part
of the healthcare system.
I was mayor of a city, and I imagine my experience is similar to that
of the Senator from Connecticut. Our hospitals before the Affordable
Care Act were having a really difficult time because so many of those
costs at the most expensive point--when a disease had become so much
more acute--were being pushed into hospital emergency rooms. My State
was having a very difficult time with the costs of that charity care.
They literally had tough choices. They weren't going to close their
doors when somebody went into diabetic shock or someone had an asthma
attack or some of those diseases were not treated at an earlier stage.
I am wondering if the Senator can help explain, in terms of
Connecticut's perspective, why this has an impact on all of us in terms
of the systemic healthcare systems that sustain our communities.
Mr. MURPHY. I think it is important to understand what the law says.
The
[[Page S3602]]
law says there is only one healthcare provider that by law has to treat
every single person who comes in the door; they can't turn away
individuals based upon their ability to pay. That is the emergency
room.
What we also know is that the emergency room is the place you get the
most expensive care. By the time you get there, you are often in
crisis. The care you receive in the emergency room is expensive, and
then all of the care you need afterward is expensive as well.
I always remember a woman from Connecticut who lost her Medicaid
coverage. In losing her Medicaid coverage, she didn't end up being able
to see a doctor for an infection she had in her foot. It was hurting
her for a long time, that infection. She didn't have Medicaid any
longer, so she just decided to let it hurt. She popped some Tylenol and
hoped it would go away. One day it was so painful that she went to the
emergency room, and it was too late. It was too late. Her foot had
become so badly infected that she had to have that foot--that leg below
her knee--amputated.
She had no insurance, so we all picked up the cost of that, but she
had her life altered in a way that is hard for us to fathom, and there
is not a single winner in that scenario because, obviously, her entire
life is changed because of that.
It is not as if we had saved any money in treating her so shabbily
because we ended up having to cover all of those costs. That is one
story. If you think about what the House bill does, it repeats that
story millions of times over. It is morally bankrupt, but it is also
fiscally imprudent and foolish.
Mr. BOOKER. That brings up one more issue, if the Senator will
indulge me, because I just visited his State. As I was talking to a lot
of his members--being from New Jersey, there might be a small rivalry
between our two northeastern States. A couple of folks came up to me
and got in my face in a polite and joking way about how our
Constitution was formed. They talked about the Connecticut Compromise.
As you well know, this was a compromise that allowed our Republic to
form, understanding they would have two bodies, the House and Senate.
Every State would have two Members representing it. In many ways, the
Founders of our country, coming out of this, viewed this body very
differently than the other body.
Now, the other body, you served in. I am hoping maybe you can shine
some light. I have been here 3\1/2\ years. You had experience as a
House Member and as a Senator. You said something some people at home
might dismiss as hyperbolic partisanship, but I have been here 3\1/2\
years, and I have seen this body change. What frustrates me is that
when I was here for a brief period of time and Democrats were in the
majority, I heard Republicans talk about regular order, how urgent
regular order is. When we are in charge, we will have regular order.
The leader spoke publicly about this thing called ``regular order.''
The House operates on majority rule. Our Founders saw that as a very
different body than this, which is in many ways talked about as a
different rhythm--a different way of doing things. In fact, one Senator
over here can have a lot of power within this system, sometimes to the
frustration of folks, to slow things down.
You made the claim about this being broken. This is a perfect example
of it--this idea that this would be the body, on such a big issue, that
would have a chance to be deliberative and to focus on this. I think
you are right. We have seen this body, in the very short period of time
I have been here, begin to undermine not just things that happened
under the Obama administration but to undermine traditions that go back
decades, if not more than a century.
I wonder if, being that State, as I was told, so critical to our
Constitution, you could give some light on why you really are
substantively, factually saying that this is probably one of the low
moments of the Senate in the way that this process is being done.
Mr. MURPHY. There is, right outside this Chamber, a picture of the
authors of the Connecticut Compromise, two of the Connecticut delegates
to the Constitutional Convention.
Mr. BOOKER. They might have been born in New Jersey.
Mr. MURPHY. I appreciate that shout out to Connecticut. You are
right. The idea of the House is that it is supposed to respond,
perhaps, more quickly to the temporary passions of the public, which is
ironic, given that the passion of the public today is in deep
opposition to this piece of legislation. Unfortunately, the House is
responding to the passions of one very small portion of the public,
which is the extreme Republican base, which maybe is the only remaining
segment of this country that supports the American Health Care Act.
This place is supposed to be able to step back and look at the long
term and look at the long view. That is why we have 6-year terms, so we
don't do something that may feel good in the moment politically but has
devastating impacts over the course of time. That is exactly what this
debate is about. It is about a massive reordering of one-fifth of our
economy that has just enormous consequences over time, when these
people who lose insurance start to feel the effects of that as they
bleed through their savings over 5 or 10 years and go bankrupt at the
back end of that time period.
So this is a place where both parties should be able to sit down and
talk about what this really means for folks. I thought Senator Schatz
put it well. When you don't engage in regular order, not only do you do
things that are very partisan and political, but you also do things
that don't make sense.
One of the things that regular order brings is the ability to talk to
experts. We all sit on committees, and those committees bring experts
to the table to tell us what the impact of legislation is. There has
been no committee process on this bill. We haven't had a single
committee meeting. We had one hearing in the HELP committee upon which
I sit.
So as Senator Schatz said, the result is a product that is garbage--
that, logistically, does not work because neither the House nor the
Senate engaged in the kind of deliberation that would get you to the
facts. Yes, this place is supposed to work differently, but also you
are supposed to use the committee process to make sure that you are not
passing something that just makes sense politically but makes sense
from a policy standpoint as well.
Mr. BOOKER. I thank Senator Murphy for giving me those few moments.
I wonder if the Chair would recognize me to give a few remarks
myself.
The PRESIDING OFFICER. The Senator from New Jersey is recognized.
Mr. BOOKER. Thank you very much, Mr. President.
I want to pick up on that conversation that we were having, in which
Senator Murphy laid plain on his charts about larger issues with this
bill. I want to get back to the point he was just talking about and
that I observed here in the Senate for about 3\1/2\ years, and that is
the functioning of this body. I love history. I am one of these guys
who doesn't read any fiction any more. I love reading about this
country, about its past leaders, about great moments in history.
What is interesting about this body is that, being someone who has
the privilege to stand on this floor--quite literally, given to me by
the State that I love, New Jersey--I walk on this floor and I feel a
sense of history every time I am here. It has been 3\1/2\ years, and it
hasn't lost its ``wow'' factor for me that I get to stand on this
floor. I have to say that I love my State, and in my campaigning, I
don't think the issue that I am New Jersey's first Black Senator came
up that much. New Jerseyans wanted to know: Would I come down here and
fight for them? I was aware of the history of being the fourth African
American popularly elected in the history of this body. I came down
here as a student of many of the great moments in time on this floor
and many of the records that were set.
I think some of those records are really germane to this moment right
now. The longest filibuster on this floor is where one Senator could
actually grind the workings of the Senate down to a crawl because of
Senate rules and Senate traditions. In this case, it is something I
wasn't even alive for, but something that, to me, is frustrating. But
it is a moment of history that shows what regular order is. It slows
down this body.
A filibuster takes 60 votes to overcome. So here was this moment. It
was
[[Page S3603]]
actually almost exactly 60 years ago. That was the 1957 Civil Rights
Act. It was Strom Thurmond who gave this long filibuster, trying to
block something that--yes, indeed--was going to have societal impacts
on this country--the 1957 Civil Rights Act. This is one illustration of
how, when monumental pieces of legislation come to this floor, the
history of this body and the traditions of this body are to slow things
down, to have a process, to have rules--especially for things that are
so monumental. In this case, it was the 1957 Civil Rights Act--
something on which we look back in the past and say: Wow, it took them
a long time to get there, but it demonstrates what this body's rules
have been about for a long time.
Let me go with another record that I mentioned earlier tonight, but
it shows, again, that when monumental pieces of legislation are coming,
this is a body that looks closely, takes its time, is deliberative, and
has a time-honored process. That is the other record set by the longest
consecutive session in Senate history. It was a debate about truly one
of the more important things in our society, which is issues of war and
peace. The longest consecutive session in the Senate history of debate
and of deliberation--open and public, not just for the Nation to see
but for the world to see--was a debate during the First World War about
whether to arm merchant ships. It brought about tremendous
consternation, tremendous debate, as we did the lead up to the First
World War. What is interesting is, if you think about the forming of
our country in that debate--again, the Constitutional Convention was
public, open, transparent--issues were debated. One of the fundamental
reasons for organizing our government was seen as the protection of the
American people, the ideals of a common defense, and the public
welfare. These were the things, literally, put into the preamble of our
Constitution, about what this government is about--that these are the
most important ideals. In fact, we herald some of these ideals. They
have become part of our civic gospel. Everyone knows when they hear the
words ``liberty and justice for all'' that they are part of our civic
gospel.
Part of that gospel, as well--in the core center of our country--is
that this is a nation about life, liberty, and the pursuit of
happiness. As to that word ``life,'' this government, this Republic is
affirming the ideals of life. It is only understandable when we are
debating epic pieces of legislation that will go to affect the lives of
tens of millions of Americans.
I was in the children's hospital today. Families in peril, families
in crisis were talking about the lives of their children. I have seen
it happen, unfortunately, to neighbors and people of my community. When
the lives of their children are at stake or threatened or afflicted
with disease, it puts so many things in perspective.
So here we have legislation speeding its way to the Senate floor that
goes to the fundamental ideals of this Nation. Will we be a country
that has a system of healthcare that affirms life?
When we are talking about records in the Senate, it is no coincidence
to me that one of the longest times that there was a consecutive
session in Senate history for debate--no coincidence to me--was about
war and peace. It was the rush, as some people saw it then, toward war
in World War I. What is fascinating is that folks should know that the
second longest consecutive session in Senate history was about
healthcare. It was in 2010. It was over the Affordable Care Act, a bill
that the full Senate spent 25 consecutive days considering, 160 hours.
Those 160 hours in session does not include hundreds more hours in
committee hearings, in meetings. All that took place in the development
of a bill that came to this floor and set a record about being the
second longest debate.
It is perfectly justifiable that the bill should have taken so much
time, so much focus--that the world's greatest deliberative body would
deliberate, would do its job. As for that piece of legislation, don't
believe the lie; it wasn't rushed through here. It didn't get the
express train through the Senate. It set records for discussion,
deliberation, debate, and a process that included comments, input,
thoughts, and testimony from Americans across the country--not just red
States, not just blue States, but of all Americans. It was justifiable.
It was absolutely justifiable.
I wasn't here. I was at home in Newark. I was mayor of the city.
This debate went on and on and on, and it captured the attention of
the Nation. It was something I had never seen before and I haven't seen
since. The President of the United States then, Barack Obama--this to
me was stunning; it caught my attention--was on national TV cameras.
Sure, it was C-SPAN--not what I turn to first when I am home relaxing
on my couch. But the President of the United States invited Congress
in--Republicans, some of the smartest minds. I have served here 3\1/2\
years now. Some of the smartest minds I have met in this country are
here in the Senate on the Republican side. He invited the Congress in
to discuss and debate with him on live TV healthcare. I don't know if
Reagan did that. I don't know if Bill Clinton did that. I can't
remember that they did. So here was something that was done fully in
the light, vetted, debated, deliberated, discussed in open air.
The hearing numbers are incredible. I have been here 3\1/2\ years,
and I have never seen anything like it. In the Senate's so-called HELP
Committee--Health, Education, Labor, and Pensions--they held 14
bipartisan roundtables, 13 bipartisan hearings, 20 bipartisan
walkthroughs, and they considered 300 amendments. This is the thing I
didn't know until I got to the Senate because of all the rhetoric on
24-hour cable news. This wasn't a purely Democratic bill. They actually
accepted over 160 amendments from Republicans. The stories I have heard
from people on both sides of the aisle is that they were bending over
backward trying to pick up one Republican vote, so they incurred and
took on amendments that actually shaped the bill, Republican ideas onto
this healthcare bill, 160 amendments. But stop, that is only in the
HELP Committee.
In the Senate Finance Committee, they held 17 bipartisan roundtables,
they held summits and hearings, 13 member meetings and walkthroughs, 38
meetings and negotiations, bipartisan. They held a markup. I have been
to lots of markups. I have never seen them last or scarcely can think
of times they have lasted for more than a day, but they held, in the
Finance Committee, a 7-day markup on the bill. That 7-day markup--talk
about records--that 7-day markup was the longest markup on a bill in 20
years. That was the process.
A bill affecting that fundamental American ideal that this Nation--
founded like no other, not a theocracy, not a monarchy. It is the
oldest constitutional democracy on the planet Earth that affirmed
ideals that put into the ether of Earth, for the first time, this
Constitution, talking about life, liberty, and the pursuit of
happiness. This healthcare bill involved such debate and discussion and
the Nation participated. Policy experts, market experts, medical
professionals, health nonprofits, insurers, hospitals, Americans all
got to put forward their input, their ideas. Sure, all of them were not
accepted, but everything went into the mix.
This should be shocking to the consciousness of all people of good
conscience who aren't reflexively partisan, but look at the history of
this country, a history that is proud, a history that should be
shameful about how things got done in matters of war and peace, in
matters of foreign policy and domestic, in matters like integration and
civil rights that made it possible for me to stand on the Senate floor.
There was a process, and somehow in the last 3\1/2\ years--in the name
of what? A vicious brand of partisanship that somehow undercuts not
just the voice of Democrats, not just the voice of policy experts, not
just the voice of hospital experts, not just the voice of medical
professionals--it doesn't just undercut their involvement in the
process, but it is an insult to the history and the traditions of this
body.
This was not the constitutional intent that something as important as
healthcare should be done in a back room where a small handful of
Senators are trying to hammer out amongst themselves a piece of
legislation that is going to affect tens of millions of Americans and
change our economy and change our communities. There is honor in this
place that isn't
[[Page S3604]]
on TV. There are good folks on both sides of the aisle. I have gotten
to know them. I consider folks my friends. I know their hearts. This
does not sit well the way this is being handled. I know it.
This is one of those moments of history that somebody just needs to
raise their hand and say: You know what. I might even like that bill
that comes out of that back room. I may like that bill that was
hammered out by 12 Republicans, but this process is wrong. It is an
insult to our history. I wouldn't want this done to me.
This is the moment. It is a test. History will look back and see what
this body did at this moment in history. I fear we are going to fail
the test.
What is even more painful than that, for me, is not just the sadness
or the anguish I feel about a body contorting its traditions, breaking
its way, what even hurts me more than that is what they are going to be
pushing through. We saw it in the House.
Instead of this body coming together--and literally there is
agreement on this. All of us believe the Affordable Care Act needs to
be improved. I have had it in conversations, formal and informal, that
we could build upon the Affordable Care Act. We could correct for its
deficiencies, and we could build upon its extraordinary successes.
I see those extraordinary successes in my State. I have Republicans
and Democrats who are now fearful about the consequences should a bill
like the House Republican healthcare bill be made law. There are folks
who fear for their families, fear for their children, who don't want to
go back to the Nation we had before, where the No. 1 reason for
bankruptcy was not being able to afford your medical bills, where
people with preexisting conditions were denied insurance, when mental
healthcare wasn't in parity with physical healthcare. I can go through
all the things I have seen make a huge difference in New Jersey in
communities, rural and urban, for Americans.
I want to highlight some of those right now, some of those questions
that people are asking at home about what happens if a bill like the
House bill becomes law, if they take that bill here in the Senate and
push it through, send it back to the House this bill that subverted
process, inclusion and debate and deliberation, and go to that process
called reconciliation. There are questions that are being asked.
Here is one: What happens to a mother who is pregnant with, say, her
second child who suddenly loses Medicaid coverage? Now, understand, a
very large percentage of the children born in the United States of
America are born covered by Medicaid, which we already see in this
House bill is being gutted, which is the biggest rollback in the safety
net in our country in my lifetime and more.
What happens to that mother who is pregnant with her second child and
loses her Medicaid coverage and her prenatal care? If she loses her
prenatal care along with it, what happens to that American citizen?
What happens to that baby?
Well, we know that according to the U.S. Department of Health and
Human Services, babies born to mothers who receive no prenatal care are
five times more likely to die than those whose mothers did receive
prenatal care. Tragically, women without prenatal care are three to
four times more likely to suffer maternal mortality--that means dying
in childbirth--than women with prenatal care, and these rates
significantly increase for women of color.
What happens to the tens of thousands of mothers who may lose access
to maternity services, and what happens to the already dismal infant
mortality rate and maternal mortality rates in our country if this plan
goes through? That is a legitimate question. The data is clear. You
restrict access to prenatal care, you endanger children, Americans, and
you endanger mothers.
Let's keep asking those questions. What happens to the healthcare
worker who works 60 hours a week taking care of others but loses their
own healthcare coverage and then is unable to afford getting screened
themselves, preventive screenings for cancer--let's say ovarian cancer.
What happens to them? We don't have to imagine what happens when
millions of Americans forgo preventive screenings. We have factual data
on what happens should access to those preventive screenings--like what
happened with the House healthcare bill--what would happen.
The American Cancer Society tells us clearly that inadequate health
coverage is a barrier to preventive care, early detection, and optimal
treatment. They find, for example, that patients with stage II
colorectal cancer who have it detected have higher survival rates. In
fact, they point out that people with stage II colorectal cancer with
adequate health insurance have better survival rates than people with
stage I colorectal cancer who have no health coverage. In other words,
the American Cancer Society shows that access leads to survival and
denial leads to higher rates of death.
A recent cancer study found that ``the number of Americans whose
cancers were diagnosed at the earliest stage when it was most likely to
be cured increased after ObamaCare went into effect, and more citizens
had access to health coverage.'' You take away the expanded coverage
that was founded through ObamaCare, you decrease preventive screenings,
you decrease early detention and, as indicated by the American Cancer
Society, death rates go up.
Another question, in general: What happens to cancer rates in America
when these gains are reversed? What happens when these gains are
reversed? What happens to the father of two who is diagnosed with a
rare cancer who can't afford the additional estimated $82,000? His
cancer treatment goes up if this bill, like the Republican House bill,
passes. That is what is estimated--$82,000 is what his cancer
treatments would go up. What happens when he can't afford that care,
when he is forced to choose between his family's home, for example, and
treating his cancer?
Well, this is what we know. These are the facts that from 2010 to
2016, personal bankruptcy filings have dropped close to 50 percent in
the United States of America. One of the collateral benefits of
ObamaCare is there was a 50-percent drop in personal bankruptcy
filings, with experts agreeing that the Affordable Care Act played an
important role in this significant decrease.
A group of economists has estimated that the House Republican bill
would cost the average enrollee more than $1,500 more per year than the
current system. This is despite the fact the surveys have found that
the majority of Americans have less than $1,000 in savings, with one
study finding that 63 percent of Americans don't have the savings to
cover a $500 emergency.
Remember what Senator Murphy showed? That is a bill that gives
massive tax cuts to the wealthiest of Americans, shifting the cost
burden so the average enrollee now under this bill is going to see a
$1,500-more-per-year payment when the average American doesn't have the
savings to cover about a $500 emergency.
Another question that folks are asking is, What happens to the family
whose child with a disability loses their access to home and support
services--the physical and speech therapy they receive through
Medicaid--if the Republican plan goes forward?
I was in a hospital today with such parents telling me about children
who--the only way they got the coverage was because of the expanded
Medicaid. Now what happens under the Republican plan? We know that
Medicaid is a critical lifeline for people and families with
disabilities, providing access to services such as rehabilitative
therapy to help children meet developmental goals.
One of the incredible young women, girls, I met today--because of
developmental therapy, she went from not being able to walk to now
continuing to do the things that her normal teenage peers and her twin
sister are able to do.
We know that today, 15 percent of kids are growing up with
developmental disabilities. In New Jersey, 1 in 41 children lives with
autism. But this plan that was passed in the House threatens to make it
more difficult for children with disabilities to receive the care they
need, to go to school, and to live healthy lives. Losing coverage could
mean the difference between a child with a disability achieving a
developmental milestone or falling further behind. Unfortunately, in
the Republican bill that passed the House,
[[Page S3605]]
that is exactly what will happen if it should become law.
If that bill passes, what will happen to older Americans who qualify
for Medicare but still need access to critical health services? We know
that insurance companies would likely be allowed to charge older
Americans much higher premiums under the Republican plan. Remember, it
used to be capped. The cost for older Americans used to be capped. It
is now being estimated that Americans between the ages 55 and 64 would
pay some of the highest increases. That increase would be $5,200 more
per year. Standard & Poor's actually estimated that premiums for a 64-
year-old could increase by 30 percent under the Republican bill that
passed the House.
The Congressional Budget Office noted in their report on the House
Republican health care plan that ``although the agencies expect that
the legislation would increase the number of uninsured broadly, the
increase would be disproportionately large among older people with
lower incomes, particularly people between 50 and 64 years of age with
incomes of less than 200 percent of the Federal poverty level.'' Think
about that for a second. Executives of insurance companies, pharma
companies--the richest will get tax breaks into the hundreds of
thousands of dollars, but the poorest folks, the elderly in our
community, according to the CBO, would see their costs go up
considerably.
The New Jersey Hospital Association noted that ``under current law, a
64-year-old making $26,500 a year will pay an average of $1,700 in
annual premiums.'' Under the AHCA--the Republican plan in the House--
that same individual making just above minimum wage will pay, under
their plan, between $13,600 and $16,100 in premiums. That is the
increase for older Americans, working Americans. That is the increase.
We know that as more older Americans lose their health coverage and
in turn enter Medicare in worse health, our entire Medicare system is
made weaker and less solvent.
If this bill passes, what happens to older Americans who have already
spent their life savings in nursing homes? We know that right now for
elder Americans in nursing homes, Medicaid actually covers the cost of
two out of three of those individuals.
I will quote from a piece that ran just this past weekend in the New
York Times: ``Roughly one in three people now turning 65 will require
nursing home care at some point during his or her life.''
Over three-quarters of long stay nursing home residents will
eventually be covered by Medicaid.
Many American voters think Medicaid is only for low-income adults and
their children, for people who aren't ``like them.'' But Medicaid is
not somebody else's insurance; it is an insurance for all of our
mothers and fathers and eventually for ourselves.
I continue the quote:
Mr. Trump and the Republicans would lower spending on the
frailest and most vulnerable people in our healthcare system.
They would like most Americans to believe that these cuts
will not affect them, only their ``undeserving neighbors,''
but that hides the truth that draconian cuts to Medicaid
affect all of our families. They are a direct attack on our
elderly or disabled and are dangerous.
I want to wrap up with this concluding thought: We know right now
that we are at a turning point in our country, that the process that
has made this deliberative body known throughout the land, throughout
humanity--that this deliberative body is about to alter its tradition
and have a bill that affects tens of millions of Americans done and
crafted in a back room without public input and rushed to this floor.
That is what the process is right now.
As Martin Luther King said in a speech to the medical community for
human rights in 1966, ``Of all the forms of inequality, injustice in
health care is the most shocking and inhumane.''
This bill will perpetuate injustice in our Nation. It will further
the gulf between the haves and have-nots. But it does not just target
the vulnerable, the elderly, the poor; it targets all of us. It targets
our character as a country, our highest ideals, the very core of many,
if not all, of our States. The least of these. The least of these.
We cannot allow this legislation that will so hurt our country to be
crafted in darkness behind closed doors. It subverts a mighty tradition
of the world's most deliberative body to be rushed through and cause so
much damage to so many Americans and indeed the very soul of our
country.
Mr. President, I yield the floor.
The PRESIDING OFFICER (Mr. Cruz). The Senator from Indiana.
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